Intersectionality: Mapping Critical Relations for Quality in Long-Term Care Research

Intersectionality is a useful method (Lutz, 2015) for interdisciplinary long-term care (LTC) research to advance a more critical understanding of how experiences of quality are shaped by mutually reproducing social divisions, identities and relations of power that shape LTC. This paper discusses insights from the “Mapping Care Relationships” stream of the Seniors – Adding Life to Years (SALTY) project, a pan-Canadian program of research examining clinical, social and policy perspectives on quality in LTC. “Mapping Care Relationships” mapped how promising approaches to care relationships are organized and experienced in LTC. From January 2018-August 2019 our team of nine researchers conducted rapid ethnographies in eight nursing homes, two in each of four provinces across Canada. We purposively observed and interviewed workers from a wide variety of positions and backgrounds, informed by an intersectionality approach. We traced how promising approaches in person-centred dementia care (PCDC) in particular may reify the subordinated status of care workers (some more than others) and reinforce inequities within LTC systems. In multiple LTC homes, front-line care workers described experiencing physical and emotional harm in care relationships with residents which caused them distress. However, consistent with a PCDC approach, the harm was attributed to ‘behaviours’ clinically symptomatic of dementia. In framing power differentials from a medical perspective, PCDC makes it possible to interpret harmful experiences as 'part of the job’ and something workers should know to expect, prevent, avoid, redirect, or ignore. Lutz, H. (2015). Intersectionality as method. DiGeSt. Journal of diversity and gender studies, 2(1-2), 39-44.

Peripheral Vascular Disease: A Contemporary Review

Peripheral Vascular Disease (PVD) is an emerging public health problem in Bangladesh that has tremendous social and economic implications. Unfortunately, there is a general lack of adequate understanding about this disease among primary care physicians and common people. This is why patients present late to vascular care which poses significant difficulties in the treatment and increases cost burden. Late presentation also increases the rate of limb loss. Treatment of PVD is rapidly evolving with the advent of endovascular modalities. The article provides a review of the basic aspects of PVD as well as the present status of care. Bangladesh Heart Journal 2019; 34(2) : 137-145

NEET as an Outcome for Care Leavers in South Africa: The Case of Girls and Boys Town

A well-documented outcome for emerging adults in determining their “success” is whether they are Not in Employment, Education, or Training (NEET) or engaged in Education, Employment, and Training (EET). Being NEET can create psychological, emotional, financial, and health challenges and is a significant risk factor in youth making successful transitions into adulthood. This article describes and compares the NEET and EET status of care leavers from Girls and Boys Town after 1 and 2 years and in relation to other outcomes. The results suggest that while care leavers’ NEET rates are high, they are not significantly higher than those of the South African general population as seen elsewhere in the world. Furthermore, being NEET is associated with more negative care leaving outcomes than being EET; however, this article also highlights the vulnerability of those who are EET. Relationships with family and support networks play a critical role in helping and supporting these youth.

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OBJECTIVES/SPECIFIC AIMS: Approximately 50% of people who have been diagnosed with HIV are either not linked to a care provider or not retained in medical care. This has substantial implications for both individual and public health outcomes. On an individual level, being retained in care is necessary for continuous receipt of antiretroviral therapy and sustained viral suppression. The public health implications of poor retention in HIV care are also serious, as it is estimated that people with HIV who are not retained in medical care are responsible for a majority of HIV transmissions, even more than the number of transmissions attributable to those who are HIV infected but undiagnosed. State departments of health routinely collect surveillance data including positive HIV test results, CD4 counts and viral load measures for monitoring trends in HIV infection. A shift in the use of these surveillance measures, guided by the CDC, has brought forth the opportunity to use these data for direct patient services and, more specifically, to direct re-engagement and retention in care efforts. Although the risk factors for poor retention in HIV care have been characterized using information from individual or multiple clinics, this study seeks to incorporate state surveillance data into the retention measures. METHODS/STUDY POPULATION: This retrospective cohort study was performed at the University of Alabama at Birmingham 1917 HIV/AIDS Clinic among patients with at least one attended HIV primary care visit during the calendar year of 2015. Retention during the calendar year of 2016 was then measured as whether or not a patient had 2 or more completed clinic visits which were separated by more than 90 days (in accordance with the Health Resources and Services Administration or HRSA guidelines, a National HIV Quality Indicator). For patients who did not have any primary care visit in 2016, the Alabama Department of Public Health will provide a status of care (out of care, in care elsewhere, died, moved out of state, and cannot locate) based on HIV laboratory results reported from all clinics and labs across the state and/or mortality information. A multinominal regression model of the status of care will be fitted to demographic, clinical, laboratory, and behavioral patient reported outcomes captured during an index visit in 2015. RESULTS/ANTICIPATED RESULTS: Data were recently obtained and is currently being analyzed on 3107 patients included in this study. We anticipate that there will be differences in the factors significantly associated with patients classified as out of care, poorly retained (patients who have only one completed clinic visit), and retained in care by the HRSA measure during calendar year 2016. DISCUSSION/SIGNIFICANCE OF IMPACT: By incorporating state surveillance data into our analysis, we expect to obtain a more precise picture of the risk factors for poor retention among HIV patients. For the first time, we will be able to determine if patients lost to our HIV clinic (~10% annually) are entirely lost to medical care or are seeking care elsewhere as indicated by HIV lab data reported to public health via surveillance. Identified risk factors will then be able to better inform the efforts to proactively improve the efficiency for HIV patient retention and re-engagement, and therefore lead to better individual outcomes for HIV patients and reduce the incidence of new HIV cases.

Assessment effect of breast milk on diaper dermatitis

Diaper dermatitis is the most common dermatological disease of infancy, which occurs and caused by the combined effect of irritants such as diaper, urine and faces. In this study, we intend to evaluate the effect of breast milk on the healing of diaper dermatitis. This study was a clinical trial of 30 infants between 0-12 months of age that were suffering from diaper dermatitis and referred to the Health Centers in Tehran, Iran. The subjects were selected by open study. Infants were divided into two matched groups: case and control. Datagathering tools were the questionnaire that contained two parts: the demographic characteristics of infants and the status of care and condition of the lesion. Data analysis was performed using SPSS/18 software and Mann-Whitney and Chi-Square tests were used. The findings revealed a significant difference between the case and control groups in the number and lesion score of the rashes at the first and third day (P=0.013, P=0.005), these differences were more significant at the fifth day (P=0.004, P=0.001). Because of positive effects of breast milk on healing of diaper dermatitis, it is proposed that educational programs in health centers should be considered by health officials, and the managers would play a key role in increasing knowledge behavior changes in mothers.