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Marques FRDM, Laranjeira C, Carreira L, Gallo AM, Baccon WC, Goes HDF, Salci MA. Managing long COVID symptoms and accessing health services in Brazil: A grounded theory analysis. Heliyon 2024; 10:e28369. [PMID: 38571660 PMCID: PMC10988007 DOI: 10.1016/j.heliyon.2024.e28369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
Background The worldwide community has shown significant interest in researching the management of Long COVID. However, there is scarce evidence about the daily experiences of people living with Long COVID and their insights into the healthcare services provided to them. Aims This study aims to understand the experience of Long COVID sufferers with their symptoms and in accessing health services. Method We employed Charmaz's grounded theory methodology, informed by constructivism, and applied the COREQ guidelines for qualitative research. Sixty-six Brazilians living with Long COVID participated in the study. The data was collected using semi-structured telephone interviews and analyzed using a constant comparative process. Findings The findings refer firstly to the consequences of persistent Long COVID symptoms. Secondly, they describe how the disease trajectory required Long COVID sufferers to reorganize their routines and develop adaptive strategies. Lastly, they reflect a diverse array of both positive and negative interactions inside the healthcare system conveyed by individuals suffering from Long COVID. These elements converge towards the core category of the study: "The limbo of Long COVID sufferers: between the persistence of symptoms and access to health services". Conclusions Long COVID is characterized by its varied nature, including a range of physical and emotional repercussions experienced by individuals. There is a need for enhanced comprehension and discourse about Long COVID across several domains, including the general public, policy-making entities, and healthcare professionals. In this sense, the development of specialized services or the reinforcement of existing services to support long COVID sufferers is imperative.
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Affiliation(s)
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic University of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901, Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic University of Leiria, Campus 5, Rua das Olhalvas, 2414-016 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801, Évora, Portugal
| | - Lígia Carreira
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá, 87020-900, PR, Brazil
| | - Adriana Martins Gallo
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá, 87020-900, PR, Brazil
| | - Wanessa Cristina Baccon
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá, 87020-900, PR, Brazil
| | - Herbert de Freitas Goes
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá, 87020-900, PR, Brazil
| | - Maria Aparecida Salci
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá, 87020-900, PR, Brazil
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Salci MA, Carreira L, Baccon WC, Marques FRDM, Höring CF, Oliveira MLFD, Milan NS, de Souza FCS, Gallo AM, Covre ER, Dixe MA, Querido A, Vissoci JRN, Facchini LA, Laranjeira C. Perceived quality of life and associated factors in long COVID syndrome among older Brazilians: A cross-sectional study. J Clin Nurs 2024; 33:178-191. [PMID: 36680417 DOI: 10.1111/jocn.16618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/06/2022] [Accepted: 12/31/2022] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES This paper aims to: (a) determine the personal, sociodemographic, clinical, behavioural, and social characteristics of older Brazilians with clinical evidence of long COVID; (b) evaluate perceived quality of life and determine its association with personal, sociodemographic, behavioural, clinical and social variables; and (c) assess significant predictors of high perceived QoL. BACKGROUND Given the inherent vulnerabilities of the ageing process, the older people are an at-risk group for both contagion of SARS-CoV-2 and the perpetuation of residual symptoms after infection, the so-called long COVID or post-COVID syndrome. DESIGN A cross-sectional survey design using the STROBE checklist. METHODS Brazilian older people with long COVID syndrome (n = 403) completed a phone survey measuring personal, sociodemographic, behavioural, clinical, and social characteristics, and perceived Quality of Life (QoL). Data were collected from June 2021-March 2022. A multiple linear regression model was performed to identify salient variables associated with high perceived QoL. RESULTS The mean age of participants was 67.7 ± 6.6 years old. The results of the multivariate regression model showed that race, home ownership, daily screen time, musculoskeletal and anxiety symptoms, and work situation were the significant predictors of QoL among COVID-19 survivors. CONCLUSIONS Knowledge about the persistence of physical, emotional, and social symptoms of COVID-19 can help nurses and other healthcare providers to improve the management of survivors, bringing benefits to the whole society. RELEVANCE TO CLINICAL PRACTICE Given the novelty of long-COVID and its heterogeneous trajectory, interventions focusing on the repercussions and requirements unique to more vulnerable older persons should be developed and these aspects should be included in public health recommendations and policymakers' concerns. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was required to design, to outcome measures or undertake this research. Patients/members of the public contributed only to the data collection.
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Affiliation(s)
- Maria Aparecida Salci
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | - Lígia Carreira
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | - Wanessa Cristina Baccon
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | | | - Carla Franciele Höring
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | | | - Natália Simeão Milan
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | | | - Adriana Martins Gallo
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | - Eduardo Rocha Covre
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | - Maria Anjos Dixe
- School of Health Sciences - Polytechnic of Leiria, Center for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal
| | - Ana Querido
- School of Health Sciences - Polytechnic of Leiria, Center for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal
| | - João Ricardo Nickenig Vissoci
- Emergency Medicine Division, Department of Surgery, Duke University, Durham, North Carolina, USA
- Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Luiz Augusto Facchini
- Departamento de Medicina Social, Faculdade de Medicina e Programa de Pós-Graduação em Epidemiologia e Saúde da Família e Programa de Pós-Graduação em Enfermagem, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Carlos Laranjeira
- School of Health Sciences - Polytechnic of Leiria, Center for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
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Marques FRDM, Laranjeira C, Carreira L, Gallo AM, Baccon WC, Paiano M, Baldissera VDA, Salci MA. Illness Experiences of Brazilian People Who Were Hospitalized Due to COVID-19 and Faced Long COVID Repercussions in Their Daily Life: A Constructivist Grounded Theory Study. Behav Sci (Basel) 2023; 14:14. [PMID: 38247666 PMCID: PMC10813415 DOI: 10.3390/bs14010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Long COVID is a multisystem condition that has multiple consequences for the physical, mental, and social health of COVID-19 survivors. The impact of the long COVID condition remains unclear, particularly among middle-aged and older adults, who are at greater risk than younger people of persisting symptoms associated with COVID-19. Therefore, we aimed to understand the experiences of middle-aged and older people who had been hospitalized for COVID-19 and the repercussions of long-term COVID symptoms in their daily lives. A qualitative study was carried out, adopting the framework of the constructivist grounded theory (CGT) proposed by Kathy Charmaz. Fifty-six middle-aged and older adult participants from the southern region of Brazil were recruited. Data were gathered from semi-structured telephone interviews. Concomitantly a comparative analysis was performed to identify categories and codes using the MaxQDA® software (version 2022). Three subcategories were identified: (1) experiencing COVID-19 in the acute phase; (2) oscillating between 'good days' and 'bad days' in long COVID; and (3) (re)constructing identity. These concepts interact with each other and converge upon the central category of this study: recasting oneself to the uniqueness of the illness experience of long COVID. Our findings provided insights related to the disruption in the lives of long COVID-19 sufferers who still live with persistent symptoms of the disease, including physical, social, family, emotional and spiritual repercussions. Likewise, this study may aid in developing friendly and welcoming social environments, lowering stigma and prejudice towards patients with long COVID, and fostering prompt and suitable policy support and mental health care for these individuals.
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Affiliation(s)
- Francielle Renata Danielli Martins Marques
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic University of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic University of Leiria, Rua de Santo André-66-68, Campus 5, 2410-541 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
| | - Lígia Carreira
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Adriana Martins Gallo
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Wanessa Cristina Baccon
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Marcelle Paiano
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Vanessa Denardi Antoniassi Baldissera
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Maria Aparecida Salci
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
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Barreto MDS, Marques FRDM, Gallo AM, Garcia-Vivar C, Carreira L, Salci MA. Striking a new balance: A qualitative study of how family life has been affected by COVID-19. Rev Lat Am Enfermagem 2023; 31:e4043. [PMID: 37937598 PMCID: PMC10631297 DOI: 10.1590/1518-8345.6705.4043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/07/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE to examine the repercussions of the pandemic on the family system by focusing on the perspective of family members who contracted and experienced COVID-19. METHOD an exploratory study with a qualitative approach conducted with 27 individuals who had COVID-19. Data collection took place through telephone interviews that were audio-recorded and guided by a semi-structured instrument. Data analysis was based on an inductive process supported by Reflexive Thematic Analysis. RESULTS the pandemic and illness of a family member acted as driving forces generating new and intense movements in the family system. Initially, they noticed negative repercussions such as concerns, fear, anguish, stress, distancing and social isolation. As time progressed and by using technologies to ease communication, they began to perceive positive repercussions such as increased proximity, strengthening of ties, development of new roles and care. The families also identified recovery of a balanced position, with return of certain readjustment in family dynamics and functioning. CONCLUSION health professionals need to recognize that the COVID-19 disease has imposed repercussions on family systems, proposing interventions that help families face this moment and more easily recover a balanced position for their functioning.
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Affiliation(s)
| | - Francielle Renata Danielli Martins Marques
- Universidade Estadual de Maringá, Departamento de Enfermagem, Maringá, PR, Brasil
- Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | - Adriana Martins Gallo
- Universidade Estadual de Maringá, Departamento de Enfermagem, Maringá, PR, Brasil
- Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | - Cristina Garcia-Vivar
- Universidad Pública de Navarra, Departamento de Ciencias de la Salud, Pamplona, NA, España
| | - Lígia Carreira
- Universidade Estadual de Maringá, Departamento de Enfermagem, Maringá, PR, Brasil
- Bolsista do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil
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Baccon WC, Salci MA, Carreira L, Gallo AM, Marques FRDM, Laranjeira C. "Feeling Trapped in Prison" Due to the COVID-19 Pandemic: Perceptions and Practices among Healthcare Workers and Prison Staff from a Brazilian Maximum Security Unit. Healthcare (Basel) 2023; 11:2451. [PMID: 37685485 PMCID: PMC10487085 DOI: 10.3390/healthcare11172451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
The COVID-19 pandemic had several repercussions on prison staff, but the currently available evidence has mainly ignored these effects. This qualitative study aimed to understand the impact of COVID-19 on the prison system through the narratives of health and security professionals, using the methodological framework of the constructivist grounded theory proposed by Charmaz. The sample included 10 healthcare workers and 10 security professionals. Data collection took place between October and November 2022 through individual in-depth interviews. The data were analyzed using the MaxQDA software. Three categories of interrelated data emerged: (1) "Confrontation and disruption" caused by the COVID-19 pandemic in the prison system; (2) "Between disinfodemic and solicitude" referring to the tension between information management and the practice of care centered on the needs of inmates; and, finally, (3) "Reorganization and mitigation strategies during the fight against COVID-19". Continuous education and the development of specific skills are essential to enable professionals to face the challenges and complex demands that arise in prison contexts. The daily routines professionals had previously taken for granted were disrupted by COVID-19. Thus, investing in adequate training and emotional support programs is crucial to promote the resilience and well-being of these professionals, ensuring an efficient and quality response to critical events.
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Affiliation(s)
- Wanessa Cristina Baccon
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (W.C.B.); (M.A.S.); (L.C.); (A.M.G.); (F.R.D.M.M.)
| | - Maria Aparecida Salci
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (W.C.B.); (M.A.S.); (L.C.); (A.M.G.); (F.R.D.M.M.)
| | - Lígia Carreira
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (W.C.B.); (M.A.S.); (L.C.); (A.M.G.); (F.R.D.M.M.)
| | - Adriana Martins Gallo
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (W.C.B.); (M.A.S.); (L.C.); (A.M.G.); (F.R.D.M.M.)
| | - Francielle Renata Danielli Martins Marques
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (W.C.B.); (M.A.S.); (L.C.); (A.M.G.); (F.R.D.M.M.)
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Campus 5, Polytechnic University of Leiria, Rua de Santo André-66-68, 2410-541 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
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Baccon WC, Salci MA, Carreira L, Gallo AM, Marques FRDM, Paiano M, Baldissera VDA, Laranjeira C. Meanings and Experiences of Prisoners and Family Members Affected by the COVID-19 Pandemic in a Brazilian Prison Unit: A Grounded Theory Analysis. Int J Environ Res Public Health 2023; 20:6488. [PMID: 37569028 PMCID: PMC10419247 DOI: 10.3390/ijerph20156488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023]
Abstract
Worldwide, the COVID-19 pandemic represented a health emergency for prisons. This study sought to understand the meanings and experiences through the narratives of prisoners and family members affected by the COVID-19 pandemic in the context of a maximum-security state penitentiary complex in southern Brazil. For this purpose, a qualitative study was developed based on the methodological framework of constructivist grounded theory. Data were collected between February and August 2022 through individual in-depth interviews and field notes. The sample consisted of 41 participants: 28 male prisoners, and 13 family members. Guided by the Charmaz method of grounded theory analysis, the study afforded the core category "Feeling trapped in prison during the COVID-19 pandemic" with three interrelated phases: "Triggering", "Escalating", and "Readjustment". The "Triggering" phase refers to COVID-19-related elements or events that triggered certain reactions, processes, or changes in prison. During the "Escalating" phase, participants became overwhelmed by the suffering caused by incarceration and the pandemic crisis. The "Readjustment" phase involved adapting, reorienting, or reformulating previous approaches or strategies for dealing with a specific situation. Prisons faced complex challenges during the pandemic and were forced to prioritize protecting public health. However, the measures adopted must be carefully evaluated, ensuring their needs and that they are based on scientific evidence. The punitive approach can undermine inmate trust in prison authorities, making it difficult to report symptoms and adhere to preventive measures.
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Affiliation(s)
- Wanessa Cristina Baccon
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (W.C.B.); (M.A.S.); (L.C.); (A.M.G.); (F.R.D.M.M.); (M.P.); (V.D.A.B.)
| | - Maria Aparecida Salci
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (W.C.B.); (M.A.S.); (L.C.); (A.M.G.); (F.R.D.M.M.); (M.P.); (V.D.A.B.)
| | - Lígia Carreira
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (W.C.B.); (M.A.S.); (L.C.); (A.M.G.); (F.R.D.M.M.); (M.P.); (V.D.A.B.)
| | - Adriana Martins Gallo
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (W.C.B.); (M.A.S.); (L.C.); (A.M.G.); (F.R.D.M.M.); (M.P.); (V.D.A.B.)
| | - Francielle Renata Danielli Martins Marques
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (W.C.B.); (M.A.S.); (L.C.); (A.M.G.); (F.R.D.M.M.); (M.P.); (V.D.A.B.)
| | - Marcelle Paiano
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (W.C.B.); (M.A.S.); (L.C.); (A.M.G.); (F.R.D.M.M.); (M.P.); (V.D.A.B.)
| | - Vanessa Denardi Antoniassi Baldissera
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (W.C.B.); (M.A.S.); (L.C.); (A.M.G.); (F.R.D.M.M.); (M.P.); (V.D.A.B.)
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
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Araujo JP, Gallo AM, Parada CMGDL, Marcon SS, Ferrari RAP, Pinto KRTDF, Zani AV. Mobile applications as a strategy to support parents in the care of newborns: a scoping review. Rev Esc Enferm USP 2023; 57:e20220470. [PMID: 37494035 PMCID: PMC10373450 DOI: 10.1590/1980-220x-reeusp-2022-0470en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/29/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To map and describe studies available in the literature about mobile applications to support parents in newborn care and data from applications accessible in online stores. METHOD This is a scoping review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The searches were carried out in theses and dissertations databases and portals, in September 2021, and articles, theses, and dissertations were included. An independent search was performed in online stores of applications for operating systems Android and iOS, in October and December 2021, and applications with content to support parents of newborns were selected. RESULTS A total of 5,238 studies and 757 applications were found, and of these, 16 and 150, respectively, composed the sample. The topics discussed in the studies were: care, breastfeeding, fever, identification of neonatal diseases, child growth and development. In the applications, the themes found were care, breastfeeding, growth, immunization, development, sleep, tips, and guidelines. CONCLUSION Applications are important support tools for parents, as they are an innovative means and accessible to a large part of the population.
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Hershberger P, Gallo AM, Gruss V, Steffen AD, Adlam K, Driessnack M, Grotevant HD, Klock SC, Pasch L. P-488 Perceptions of gamete and embryo donation recipient parents about the online experimental and control programs in the TELL Tool feasibility clinical trial at immediate post-test. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Study question
What are parents’ initial perceptions about the online experimental and control programs at immediate post-test?
Summary answer
Parents reported overall acceptability of the online instructions, technological navigation, length, and quality of videos, as well as suggestions for further improvement.
What is known already
Multiple investigations have examined the reasons why parents who used donated gametes or embryos, decide to inform their children that they were conceived through third-party reproduction. A consistent theme in this research is parental calls for strategies and tools to aid parents with disclosure to their children. Despite these calls from parents, little research has focused on developing new methods of delivering parent-focused materials that aim to assist parents in their disclosure process. To address this concern, we developed an online experimental program called the Tool to Empower Parental TeLling and TaLking (TELL Tool) and completed alpha testing.
Study design, size, duration
A 3-month feasibility clinical trial.
Participants/materials, setting, methods
Donor sperm, egg, and embryo recipient parents were randomized to either an experimental TELL Tool program or a control program focused on good parenting practices. Both the TELL Tool and the control programs are administered online. To date 13 parents have completed the experimental or control program and each participant has answered an immediate post-test survey about the acceptability of the program. Descriptive statistics and qualitative content analysis guided the analysis.
Main results and the role of chance
The sample consists of 13 U.S. parents between 35 to 53 years (M = 41.3 years). The parents used donated sperm (n = 5), eggs (n = 2), sperm and eggs (n = 2) or embryos (n = 4) and their children were between 1 to 12 years (M = 5.7 years). Most parents were female (n = 11) and White (n = 10). Parents were asked to rate the level of truthfulness about the acceptability of the online programs (ratings: 1 to 5, with 1 being “not at all true” to 5 being “very true”). Responses about the: (1) instructions provided for accessing the program were easy, were: range 3 to 5, M = 3.9; (2) technological navigation within the program was problematic, were: range 1 to 5, M = 2.7; (3) length of the program was too long, were: range 1 to 5, M = 3; and (4) videos within the program were helpful, were: range 3 to 5, M = 3.69. Responses to the open-ended questions provided insights to the ratings, such as parents’ statements about specific technological issues (e.g., ability to print resources, ease of navigating in-and-out of the program).
Limitations, reasons for caution
Preliminary data are reported for the feasibility trial at the immediate post-test timepoint as recruitment is ongoing. As the 3-month study unfolds, additional data will be obtained to allow for more in-depth understanding of parents’ perceptions about the acceptability of the experimental TELL Tool and control programs.
Wider implications of the findings
The acceptability of the online research for donor gamete and embryo recipient parents may illuminate access issues to these often hidden and dispersed parents and their families across the lifespan. Parents’ responses can provide a window of understanding for other decision aids that target health promotion among parents and children.
Trial registration number
NCT04841967
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Affiliation(s)
- P Hershberger
- University of Illinois Chicago, Population Health Nursing Science , Chicago, U.S.A
| | - A M Gallo
- University of Illinois Chicago, Human Development Nursing Science , Chicago, U.S.A
| | - V Gruss
- University of Illinois Chicago, Biobehavioral Nursing Science , Chicago, U.S.A
| | - A D Steffen
- University of Illinois Chicago, Population Health Nursing Science , Chicago, U.S.A
| | - K Adlam
- University of Illinois Chicago, Human Development Nursing Science , Chicago, U.S.A
| | - M Driessnack
- Oregon Health & Science University, School of Nursing , Portland, U.S.A
| | - H D Grotevant
- University of Massachusetts Amherst, Psychological and Brain Sciences , Amherst, U.S.A
| | - S C Klock
- Northwestern University, Obstetrics and Gynecology and Psychiatry and Behavioral Sciences , Chicago, U.S.A
| | - L Pasch
- University of California San Francisco, Psychiatry and Behavioral Sciences , San Francisco, U.S.A
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9
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Santos Vieira R, Martins Gallo A, Aparecido de Carvalho CJ, Pagliari Araujo J, Cabral R, Eler GJ. Risk factors for developing cardiovascular disease in women. Invest Educ Enferm 2017; 35:35-47. [PMID: 29767922 DOI: 10.17533/udea.iee.v35n1a05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 01/31/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the factors that predispose to the development of cardiovascular diseases in women who were attended at a Basic Health Unit in Londrina, Paraná, Brazil. METHODS The research was characterized as observational and quantitative. The population sample consisted of 60 women aged over 18 years, being chosen at random. For data collection, mHealth Data Collector (mHDC), a mobile device, was used with a questionnaire on daily habits, health status, and disease. Measurements were made of glucose and blood cholesterol, blood pressure and anthropometric measurements. Data collection took place in February 2014 to November 2014. RESULTS Risk factors were overweight / obesity (63.8%) and sedentary lifestyle (65%), followed by family history of cardiovascular disease (43.3%), hypercholesterolemia (38.3%), and hypertension (13.3%). CONCLUSIONS This population of women presented risk factors for the development of cardiovascular disease in all ages, being necessary the implementation of measures that stimulate changes in the daily habits and improve health conditions among women by the health team.
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10
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Gallo AM, Schmeissing K, Langman CB. Think of genetic hypercalciuria when a child has urinary tract findings. J Pediatr Health Care 1999; 13:7-11. [PMID: 10085833 DOI: 10.1016/s0891-5245(99)90094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Genetic hypercalciuria, one of the most common mineral disorders in childhood, is frequently associated with a variety of urinary tract problems. Identifying and treating genetic hypercalciuria alleviates urinary tract problems and optimizes peak bone mass growth in affected children. Advanced practice pediatric nurses play a key role in identifying and coordinating care for children with genetic hypercalciuria.
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Affiliation(s)
- A M Gallo
- College of Nursing, Department of Maternal-Child Nursing, University of Illinois at Chicago, USA
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11
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Abstract
PURPOSE To examine how parents respond to and manage the challenges of childhood chronic illness. DESIGN Qualitative, comparative, secondary analysis. PARTICIPANTS Fifty-eight families (55 mothers, 44 fathers) with a school-age child (6-15 years old) with a chronic illness. RESULTS Three approaches to illness management were identified: strict adherence, flexible adherence, and selective adherence. These approaches varied in the extent to which parents developed and relied on target management behaviors that concurred with or deviated from the treatment plan prescribed by healthcare providers. CONCLUSIONS The three management approaches contribute to understanding the processes associated with differing interactions between healthcare professionals and parents when a child has a chronic illness.
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Affiliation(s)
- A M Gallo
- College of Nursing, University of Illinois at Chicago, USA.
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12
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Connelly S, Andrews JL, Gallo AM, Kayda DB, Qian J, Hoyer L, Kadan MJ, Gorziglia MI, Trapnell BC, McClelland A, Kaleko M. Sustained phenotypic correction of murine hemophilia A by in vivo gene therapy. Blood 1998; 91:3273-81. [PMID: 9558383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hemophilia A is caused by a deficiency of blood coagulation factor VIII (FVIII) and has been widely discussed as a candidate for gene therapy. While the natural canine model of hemophilia A has been valuable for the development of FVIII pharmaceutical products, the use of hemophiliac dogs for gene therapy studies has several limitations such as expense and the long canine generation time. The recent creation of two strains of FVIII-deficient mice provides the first small animal model of hemophilia A. Treatment of hemophiliac mice of both genotypes with potent, human FVIII-encoding adenoviral vectors resulted in expression of biologically active human FVIII at levels, which declined, but remained above the human therapeutic range for over 9 months. The duration of expression and FVIII plasma levels achieved were similar in both hemophiliac mouse strains. Treated mice readily survived tail clipping with minimal blood loss, thus showing phenotypic correction of murine hemophilia A by in vivo gene therapy.
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Affiliation(s)
- S Connelly
- Holland Laboratory, American Red Cross, Rockville, MD, USA
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13
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Gallo AM. Building strong bones in childhood and adolescence: reducing the risk of fractures in later life. Pediatr Nurs 1996; 22:369-74, 422. [PMID: 9087068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The current focus on reducing the risk of osteoporosis and skeletal fractures in later life has placed an emphasis on the role of calcium in building strong bones during childhood and adolescence. Recent National Institutes of Health (NIH) Consensus Development Conference recommendations for optimal calcium intake encourage increased intake. Strategies to enhance optimal calcium intake in children and adolescents include dietary choices and the use of supplements.
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Affiliation(s)
- A M Gallo
- Department of Maternal-Child Nursing, University of Illinois at Chicago, College of Nursing, USA
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14
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Knafl KA, Ayres L, Gallo AM, Zoeller LH, Breitmayer BJ. Learning from stories: parents' accounts of the pathway to diagnosis. Pediatr Nurs 1995; 21:411-5. [PMID: 8684841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although the diagnosis of a child's chronic illness is typically a stressful time for parents, the events leading up to it vary considerably across families. As part of a larger study that addressed the experience of living with chronic illness, an analysis was undertaken to identify major themes in parental reports of the events preceding their child's diagnosis of chronic illness. Data are based on accounts given by parents in 63 families from three health science centers in the midwestern United States. Narrative analysis techniques were used to identify 5 major pathways to diagnosis (direct, delay, detour, quest, ordeal) and to explore parents' perceptions of the nature and quality of their interactions with health care providers. Results are discussed in terms of their implications for initiating positive working relationships between parents and health care providers.
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15
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Gallo AM. Firearm death and injury in children and adolescents is also a serious problem. Pediatr Nurs 1994; 20:84. [PMID: 8159492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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16
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Gallo AM, Breitmayer BJ, Knafl KA, Zoeller LH. Mothers' perceptions of sibling adjustment and family life in childhood chronic illness. J Pediatr Nurs 1993; 8:318-24. [PMID: 8271153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Researchers who study the effects of chronic illness on well siblings have generally focused on individual characteristics and their relationships with psychological adjustment. More recently, researchers suggest that sibling adjustment can be best understood within the context of the family. The purpose of this study was to examine variations in sibling behavioral adjustment in relation to mothers' perceptions of the illness experience and family life. Based on mothers' ratings on the behavior problem scale of the Child Behavior Checklist (CBCL), five siblings considered poorly adjusted and five very well-adjusted siblings were compared with respect to mothers' reports of individual family member's response to illness, illness management, parenting philosophy, presence of other stressors, availability of social supports, and impact of illness on family members and family life. Two major differences were found between mothers who rated healthy siblings either poorly or very well adjusted: (a) effects of illness on the healthy sibling, the ill child, and the marital relationship and (b) perceived controllability of the chronic illness. Devising ways of helping mothers feel confident in managing their child's illness is integral to creating an environment that promotes optimal development of their ill child and the child's siblings.
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Affiliation(s)
- A M Gallo
- College of Nursing, University of Illinois at Chicago 60612
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17
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Gallo AM. Demands of labor, not conflicts, cause mothers to "hold back". MCN Am J Matern Child Nurs 1993; 18:74-6. [PMID: 8492650 DOI: 10.1097/00005721-199303000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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18
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McCarthy SM, Gallo AM. A case illustration of family management style. J Pediatr Nurs 1992; 7:395-402. [PMID: 1291675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Chronic illness management is a way of life for many children and their families. For these chronically ill children, the ability of the family to respond to the daily relentless demands of management dictates the quality of the child's and family's life. In an effort to better understand how a family responds to a chronic illness, Knafl and Deatrick's Family Management Style (FMS) model is applied to a family with a child with type I diabetes using a case-study analysis. Gallo derived dimensions of the model's components in an earlier application. These dimensions are applied to interview data obtained on the same family 1 year later to address the dynamic nature of family management style.
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19
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Atkins CE, Gallo AM, Kurzman ID, Cowen P. Risk factors, clinical signs, and survival in cats with a clinical diagnosis of idiopathic hypertrophic cardiomyopathy: 74 cases (1985-1989). J Am Vet Med Assoc 1992; 201:613-8. [PMID: 1517140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Population characteristics, risk factors, and survival characteristics were evaluated in 74 cats with hypertrophic cardiomyopathy (HC) seen at North Carolina State University veterinary teaching hospital from 1985 to 1989, and compared with 82 clinically normal cats. The mean (+/- SD) age of cats with HC was 6.5 (4.0) years. Neutered males were at significantly greater risk (odds ratio 3.1) than neutered females. Breed, body weight, or coat color were not determined to be risk factors for HC. Tricolor cats were significantly underrepresented, probably reflecting the male predisposition for HC and not a true risk reduction associated with coat color. Forty-one cats were without clinical signs of heart disease (murmur and/or gallop sound only), 24 were in congestive heart failure, and 9 had systemic arterial embolism, 3 of which had concomitant congestive heart failure. The median survival time for 61 cats with HC, for which survival information could be obtained and that were not euthanatized on day 1, was 732 days. Survival was not affected by age at diagnosis, breed, body weight, or sex. However, clinical signs were important in determining prognosis; cats with heart rates greater than 200 beats/min survived significantly longer (median survival greater than 1,830 days) than those with heart rates greater than or equal to 200 beats/min (median survival = 152 days). Cats without clinical signs (median survival greater than 1,830 days) survived longer than those with clinical signs, and cats in heart failure survived a median of 92 days, compared with 61 days for those with systemic arterial embolism. Analysis of survival revealed no significant difference between the 2 groups of cats with clinical signs; however, all cats with embolism and only 60% of cats with heart failure were dead 6 months after diagnosis.
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Affiliation(s)
- C E Atkins
- Department of Companion Animal and Special Species Medicine, College of Veterinary Medicine, North Carolina State University, Raleigh 27606
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20
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Obrecht JA, Gallo AM, Knafl KA. A case illustration of family management style in childhood end stage renal disease. ANNA J 1992; 19:255-9; discussion 260. [PMID: 1627007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Families of children with end stage renal disease (ESRD) experience their situation based on how they define the illness, manage it, and view the consequences of the illness on the family and individual family members. The purpose of this study was to describe how a family with a child with ESRD defined and managed their situation. Interviews with individual family members from two separate interview sessions were analyzed. The family's management style changed from struggling to adaptive over a 1-year period following the child's kidney transplant.
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21
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Breitmayer BJ, Gallo AM, Knafl KA, Zoeller LH. Social competence of school-aged children with chronic illnesses. J Pediatr Nurs 1992; 7:181-8. [PMID: 1625174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study examines social competence among 67 chronically ill children, aged 7 to 14 years, whose families participated in a grounded theory study of how families define and manage a child's chronic illness. Child Behavior Check List ratings (Achenbach & Edelbrock, 1983) by both fathers and mothers indicated a significantly greater risk for social competence difficulties among the chronically ill children as compared with the normative sample. Case vignettes, drawn from extensive interviews with family members, are used to show contrasting styles of family management and child coping and to suggest nursing interventions aimed at fostering social competence.
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22
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Gallo AM, Schultz VA, Breitmayer BJ. Description of the illness experience by adolescents with chronic renal disease. ANNA J 1992; 19:190-3, 214; discussion 194. [PMID: 1586232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to describe the illness experience of five adolescents with chronic renal disease. The adolescents described how renal disease had affected themselves and their daily lives. Implications for nurses when interacting with adolescents with renal disease are discussed.
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Abstract
This study describes infant feeding practices over the first year of life for 294 medically indigent, inner city mothers. These findings highlight the need for interventions to improve infant feeding knowledge and practices throughout the first year of life. Nutritional problems identified included low rates of breast-feeding; early introduction of solid food, especially cereal in the bottle; and excessive use of foods that are high in sugar.
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24
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Gallo AM, Breitmayer BJ, Knafl KA, Zoeller LH. Well siblings of children with chronic illness: parents' reports of their psychologic adjustment. Pediatr Nurs 1992; 18:23-7. [PMID: 1542522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article examines the psychologic adjustment among 28 well siblings of children with chronic illness, ages 6 to 16, as measured by parents' rating on the Child Behavior Checklist. Results indicate that, as a group, well siblings do not experience a higher incidence of behavior and social competence problems than the normative sample. These data suggest that well siblings may not be uniformly at greater risk for maladjustment. Sibling adjustment may be selective and vary depending on specific child characteristics and family environment influences.
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Abstract
When a child is diagnosed with a chronic illness, families adapt by drawing on the perceptions of individual family members, on the family's existing resources, and on new resources. This method of family adaptation has been described by McCubbin and Patterson in their Family Adaptation Model. The Family Adaptation Model is illustrated through a case study of a family's experience with type I diabetes. The model and case study yield a list of nursing assessments and interventions for families with a chronically ill child.
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Gallo AM, Breitmayer BJ, Knafl KA, Zoeller LH. Stigma in childhood chronic illness: a well sibling perspective. Pediatr Nurs 1991; 17:21-5. [PMID: 2000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to describe how well siblings view potential stigma in childhood chronic illness. Results of interview of 27 siblings are discussed using three major categories: revealing of the chronic illness to others, responses to the ill child, and impact of the illness on daily living.
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Abstract
A case analysis of a family's experience with juvenile diabetes is used to illustrate the three interactive components of the family management style (FMS) model proposed by Knafl and Deatrick. Family members' definition of the situation, management behaviors, and their sociocultural context are described and related. A shared family management style was derived from these descriptions and relationships.
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Salmon JW, Gallo AM. Gesundheitstag. Lessons from the West German health movement. Health PAC Bull 1985; 16:18-9. [PMID: 10271462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Gallo AM, Edwards J, Vessey J. Indochina moves to main street: little refugees with big needs. RN 1980; 43:45-8. [PMID: 6905243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Gallo AM. Early childhood masturbation: a developmental approach. Pediatr Nurs 1979; 5:47-9. [PMID: 257334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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