COVID-19 Pandemisinde Sağlık Hizmetlerine Erişim: Çocuk Sağlığı Nasıl Etkilendi?

Yıl 2021, Cilt: 21 Sayı: 2, 149 - 156, 20.09.2021

Zeynep Aközlü Özlem Öztürk Şahin

Öz

COVID-19, Dünya Sağlık Örgütü tarafından 11 Mart 2020 tarihinde pandemi olarak ilan edilmiştir. Hastalığın yüksek bulaşıcılığı nedeniyle tüm dünyada sağlık hizmetleri sunumunda değişikliklere gidilmiş, sağlık otoriteleri acil nedenler dışında hastane başvurularının azaltılması çağrıları yapmıştır. Viral yayılımı önlemek için uygulanan kısıtlamalar, hastalığın belirsizliğine ilişkin korkular, sağlık profesyonellerinin enfekte hastaların takibi, tedavisi ve bakımına yönlendirilmesi, kişisel koruyucu ekipman eksikliği ve pandeminin getirdiği finansal zorluklar nedeniyle COVID-19 dışı sağlık hizmetlerine erişim oranlarında keskin bir düşüş yaşanmıştır. COVID-19’un neden olduğu bu durumdan en çok etkilenen popülasyon şüphesiz ki çocuklar olmuştur. Sağlık hizmeti sunumundaki değişiklikler nedeniyle ana-çocuk sağlığı hizmetleri sekteye uğramış, bağışıklama oranları büyük ölçüde azalmıştır. Enfekte hastalara müdahale edebilmek için polikliniklerin kapatılması, yataklı servisler ve ameliyathanelerin yoğun bakımlara dönüştürülmesi çocukların akut veya kronik hastalıklarının tanı ve tedavilerinde gecikmelere neden olmuştur. Kronik hastalığı olan çocuklar ilaç veya tıbbi ekipman sıkıntısı yaşamış, rehabilitasyon hizmetlerine ihtiyaç duyan çocuklar destekleyici bakım alamamışlardır. Ayrıca okulların kapatılmasıyla koruyucu ruh sağlığı hizmetleri sürdürüle- memiştir. Sağlık hizmetlerine erişim oranlarındaki azalmalar, başta düşük ve orta gelirli ülkeler olmak üzere tüm dünyada çocukluk çağı mortalite ve morbiditesi üzerinde olumsuz sonuçlar doğurabilir. Türkiye’de çocuk sağlığına yönelik kazanımların sürdürülmesi ve sağlık hizmetlerinin planlanması açısından dünyadaki verilerin incelenmesi önemlidir. Dolayısıyla bu derlemede, küresel salgın sürecinde sağlık hizmetlerine erişimdeki azalmanın çocuk sağlığı üzerindeki etkilerinin incelenmesi amaçlanmıştır

Anahtar Kelimeler

COVID-19, çocuk, sağlık hizmetlerine erişim, pandemi

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Access to Health Care in the COVID-19 Pandemic: How is Children’s Health Affected?

Öz

COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020. Due to the high contagiousness of the disease, changes have been made in the provision of health services all over the world, and health authorities have made calls to reduce hospital admissions except for urgent reasons. Access to non-COVID-19 healthcare services has declined sharply due to the restrictions imposed to prevent viral spread, fears about the uncertainty of the disease, the redirection of healthcare professionals to the follow-up, treatment and care of infected patients, the lack of personal protective equipment, and the financial difficulties brought on by the pandemic. The population most affected by this situation caused by COVID-19 has undoubtedly been children. Due to changes in health service delivery, maternal and child health services have been interrupted, and immunization rates have decreased greatly. The closure of outpatient clinics, inpatient services and the conversion of operating rooms to intensive care units in order to intervene with infected patients have caused delays in the diagnosis and treatment of acute or chronic diseases in children. Children with chronic diseases experienced shortages of drugs or medical equipment, and children who needed rehabilitation services could not receive supportive care. In addition, preventive mental health services could not be maintained with the closure of schools. Decreases in access to health services may have negative consequences on childhood mortality and morbidity all over the world, especially in low and middle-income countries. It is important to examine the data in the world in terms of maintaining the achievements for child health and planning health services in Turkey. Therefore, this review aimed to examine the effects of the decrease in access to health services on child health during the global epidemic process. 

Anahtar Kelimeler

COVID-19, child, health care access, pandemic

Proje Numarası

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Kaynakça

• 1. Qazi SH, Saleem A, Pirzada AN, Hamid LR, Dogar SA, Das JK. Challenges to delivering pediatric surgery services in the midst of COVID 19 crisis: experience from a tertiary care hospital of Pakistan. Pediatr Surg Int 2020;36(11):1267-73. doi:10.1007/ s00383-020-04721-0. google scholar
• 2. Silvagni D, Baggio L, Lo Tartaro Meragliotta P. Neonatal and pediatric emergency room visits in a tertiary center during the COVID-19 pandemic in Italy. Pediatr Rep 2021;13(2):168-76. doi:10.3390/pediatric13020023. google scholar
• 3. Taddei M, Bulgheroni S. Facing the real time challenges of the COVID-19 emergency for child neuropsychology service in Milan. Res Dev Disabil 2020;107:103786. doi:10.1016/j.ridd.2020.103786. google scholar
• 4. Poppe M, Aguiar B, Sousa R, Oom P. The impact of the COVID-19 pandemic on children’s health in Portugal: The parental perspective. Acta Med Port 2021;34(5):355-61. doi:10.20344/amp.14805. google scholar
• 5. Wirrell EC, Grinspan ZM, Knupp KG, vd. Care delivery for children with epilepsy during the COVID-19 pandemic: An international survey of clinicians. J Child Neurol 2020;35(13):924-33. doi:10.1177/0883073820940189. google scholar
• 6. Bong CL, Brasher C, Chikumba E, Mcdougall R, Mellin-Olsen J, Enright A. The COVID-19 pandemic: Effects on low- and middle-income countries. Anesth Analg Published online 2020:86-92. doi:10.1213/ANE.0000000000004846. google scholar
• 7. Dayal D, Gupta S, Raithatha D, Jayashree M. Missing during COVID-19 lockdown: Children with onset of type 1 diabetes. Acta Paediatr Int J Paediatr 2020;109(10):2144-6. doi:10.1111/apa.15443. google scholar
• 8. Zar HJ, Dawa J, Fischer GB, Castro-Rodriguez JA. Challenges of COVID-19 in children in low- and middle-income countries. Paediatr Respir Rev 2020;35:70-4. doi:10.1016/j.prrv.2020.06.016. google scholar
• 9. Menendez C, Gonzalez R, Donnay F, Leke RGF. Avoiding indirect effects of COVID-19 on maternal and child health. Lancet Glob Heal 2020;8(7):863-4. doi:10.1016/S2214-109X(20)30239-4. google scholar
• 10. Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Heal 2020;4(5):10-1. doi:10.1016/ S2352-4642(20)30108-5. google scholar
• 11. Chanchlani N, Buchanan F, Gill PJ. Addressing the indirect effects of COVID-19 on the health of children and young people. CMAJ 2020;192(32):921-7. doi:10.1503/cmaj.201008. google scholar
• 12. Roberton T, Carter ED, Chou VB, vd. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Heal 2020;8(7):901-8. doi:10.1016/S2214-109X(20)30229-1. google scholar
• 13. UNICEF. Maternal and newborn health and COVID-19. United Nations International Children’s Emergency Fund. Published 2021. Son Erişim 1 Haziran 2021. https://data.unicef.org/topic/maternal-health/covid-19/. google scholar
• 14. Balogun M, Banke-Thomas A, Sekoni A, vd. Challenges in access and satisfaction with reproductive, maternal, newborn and child health services in Nigeria during the COVID-19 pandemic: A cross-sectional survey. PLoS One 2021;16(May):e0251382. doi:10.1371/ journal.pone.0251382. google scholar
• 15. Pant S, Koirala S, Subedi M. Access to maternal health services during COVID-19. Eur J Med Sci 2020;2(2):48-52. doi:10.46405/ ejms.v2i2.110. google scholar
• 16. Wu H, Sun W, Huang X, vd. Online antenatal care during the COVID-19 pandemic: Opportunities and challenges. J Med Internet Res 2020;22(7):e19916. doi:10.2196/19916. google scholar
• 17. Tanvir Ahmed, Ahmed Ehsanur Rahman, Taiwo Gboluwaga Amole, Hadiza Galadanci, Mushi Matjila, Priya Soma-Pillay, et al. The effect of COVID-19 on maternal newborn and child health (MNCH) services in Bangladesh, Nigeria and South Africa: call for a contextualised pandemic response in LMICs. Int J Equity Health 2021;20(1):1-6. doi:10.1186/s12939-021-01414-5. google scholar
• 18. Subhash Chandir, Danya Arif Siddiqi, Mariam Mehmood, Hamidreza Setayesh, Muhammad Siddique, Amna Mirza et al. Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: An analysis of provincial electronic immunization registry data. Vaccine. 2020;38(45):7146-55. doi:10.1016/j.vaccine.2020.08.019 google scholar
• 19. Jessica B., Joseph O, Alexander A, Lorna A, Musa S, Annettee N, et al.Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda. medRxiv. Published online 26 Nisan 2021:2021.04.23.21255940. doi:10.11 01/2021.04.23.21255940. google scholar
• 20. Buonsenso D, Cinicola B, Kallon MN, Iodice F. Child healthcare and immunizations in Sub-Saharan Africa during the COVID-19 pandemic. Front Pediatr 2020;8:517. doi:10.3389/ fped.2020.00517. google scholar
• 21. Gildner TE, Thayer ZM. Birth plan alterations among American women in response to COVID-19. Heal Expect 2020;23(4):969-71. doi:10.1111/hex.13077. google scholar
• 22. Pires PN, MacaringueC, Abdirazak A, Mucufo J, Mupueleque M, Siemens R, et al. Covid-19 pandemic impact on maternal and child dealth services access in Nampula, Mozambique: A mixed methods research. Res Sq. Published online 12 Kasım 2020:1-10. doi:10.21203/rs.3.rs-104405/v1. google scholar
• 23. Klein JD, Koletzko B, El-Shabrawi MH, Hadjipanayis A, Thacker N, Bhutta Z. Promoting and supporting children’s health and healthcare during COVID-19-International Paediatric Association Position Statement. Arch Dis Child 2020;105(7):620-4. doi:10.1136/ archdischild-2020-319370. google scholar
• 24. Siedner JM., Kraemer JD, Meyer JM., Harling G, Mngomezulu T, Gabela P, et al. Access to primary healthcare during lockdown measures for COVID-19 in rural South Africa: An interrupted time series analysis. BMJ Open 2020;10(10):43763. doi:10.1136/ bmjopen-2020-043763. google scholar
• 25. Güler S, Topuz İ, Ulusoy F. COVID-19 pandemisinde aile sağlığı merkezi çalışanlarının deneyimleri. Halk Sağlığı Hemşireliği Derg 2020;2(3):143-51. google scholar
• 26. Sidhu S, Abad-Vergara D. WHO and UNICEF warn of a decline in vaccinations during COVID-19. World Health Organization. Published 2020. Erişim 12 Mayıs 2021. https://www.who.int/ news/item/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19. google scholar
• 27. Dinleyici EC, Borrow R, Safadi MAP, van Damme P, Munoz FM. Vaccines and routine immunization strategies during the COVID-19 pandemic. Hum Vaccines Immunother 2021;17(2):400-7. doi:10.1 080/21645515.2020.1804776. google scholar
• 28. World Health Organisation. At least 80 million children under one at risk of diseases such as diphtheria, measles and polio as COVID-19 disrupts routine vaccination efforts, warn Gavi, WHO and UNICEF. World Heal Organ 2020;(May):22-5. google scholar
• 29. Khan A, Bibi A, Sheraz Khan K, Butt AR, Alvi HA, Naqvil AD ET AL. Routine Pediatric Vaccination in Pakistan During COVID-19: How Can Healthcare Professionals Help? Front Pediatr 2020;8:613433. doi:10.3389/fped.2020.613433. google scholar
• 30. Nuzhath T, Ajayi KV, Fan Q, Hotez P, Colwell B, Callaghan T. Childhood immunization during the COVID-19 pandemic in Texas. Vaccine. 2021;39(25):3333-7. doi:10.1016/j.vaccine.2021.04.050 google scholar
• 31. Fahriani M, Anwar S, Yufika A, Bakhtiar B, Wardani E, Winardi W etal. Disruption of childhood vaccination during the COVID-19 pandemic in Indonesia. Narra J 2021;1(1):1-11. doi:http://doi. org/10.52225/narraj.v1i1.7. google scholar
• 32. Piche-Renaud P-P,Ji C, FarrarMPH DS, vd. Impactof the COVID-19 pandemic on the provision of routine childhood immunizations in Ontario, Canada. medRxiv. Published online 14 Mayıs 2021:2021.05.11.21257048. doi:10.1101/2021.05.11.21257048 google scholar
• 33. Zhong Y, Clapham HE, Aishworiya R, vd. Childhood vaccinations: Hidden impact of COVID-19 on children in Singapore. Vaccine 2021;39(5):780-5. doi:10.1016/j.vaccine.2020.12.054 google scholar
• 34. Suk JE, Jimenez AP, Kourouma M, vd. Post-ebola measles outbreak in lola, Guinea, January-June 2015. Emerg Infect Dis. 2016;22(6):1106-8. doi:10.3201/eid2206.151652 google scholar
• 35. WHO & UNICEF. Immunization in the context of COVID-19 pandemic. World Heal Organ United Nations Child Fund. 2020;(April):1-6. google scholar
• 36. CDC. Interim guidance for routine and influenza immunization services during the COVID-19 pandemic. Centers for Disease Control and Prevention. Published 2020. Erişim Mayıs 12, 2021. https://www.cdc.gov/vaccines/pandemic-guidance/index.html google scholar
• 37. Marques de Miranda D, da Silva Athanasio B, Sena Oliveira AC, Simoes-e-Silva AC. How is COVID-19 pandemic impacting mental health of children and adolescents? Int J Disaster Risk Reduct 2020;51:101845. doi:10.1016/j.ijdrr.2020.101845 google scholar
• 38. CDC. Children’s Mental Health. Centers for Disease Control and Prevention. Published 2021. Erişim 9 Haziran 2021. https://www. cdc.gov/childrensmentalhealth/features/kf-childrens-mental-health-report.html. google scholar
• 39. UNESCO. UNESCO rallies international organizations, civil society and private sector partners in a broad Coalition to ensure #LearningNeverStops. United Nations Educational, Scientific and Cultural Organization. Published 2020. Erişim 9 Haziran 2021. https://en.unesco.org/news/unesco-rallies-international-organizations- civil-society-and-private-sector-partners-broad. google scholar
• 40. Thakur A. Mental health in high school students at the time of COVID-19: A student’s perspective. J Am Acad Child Adolesc Psychiatry 2020;59(12):1309-10. doi:10.1016/j.jaac.2020.08.005. google scholar
• 41. Leilei Liang, Hui Ren, Ruilin Cao, Yueyang Hu, Zeying Qin, Chuanen Li, and Songli Mei. The effect of COVID-19 on youth mental health. Psychiatr Q 2020;91(3):841-52. doi:10.1007/s11126-020-09744-3. google scholar
• 42. Tang S, Xiang M, Cheung T, Xiang YT. Mental health and its correlates among children and adolescents during COVID-19 school closure: The importance of parent-child discussion. J Affect Disord 2021;279:353-60. doi:10.1016/j.jad.2020.10.016. google scholar
• 43. Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Res 2020;293:113429. doi:10.1016/j.psychres.2020.113429. google scholar
• 44. Zhou SJ, Zhang LG, Wang LL, Guo ZC, Wang JQ, Chen JC et al. Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19. Eur Child Adolesc Psychiatry 2020;29(6):749-58. doi:10.1007/s00787-020-01541-4. google scholar
• 45. Ciacchini B, Tonioli F, Marciano C, Faticato MG, Borali E, Pini A, et al. Reluctance to seek pediatric care during the COVID-19 pandemic and the risks of delayed diagnosis. Ital J Pediatr 2020;46(1):1-4. doi:10.1186/s13052-020-00849-w. google scholar
• 46. Raman R, Madhusudan M. Impact of the COVID-19 pandemic on admissions to the pediatric emergency department in a tertiary care hospital. Indian J Pediatr 2021;88(4):392. doi:10.1007/ s12098-020-03562-y google scholar
• 47. Nourazari S, Davis SR, Granovsky R, Austin R, Straff DJ, Joseph JW, et al. Decreased hospital admissions through emergency departments during the COVID-19 pandemic. Am J Emerg Med 2021;42:203-10. doi:10.1016/j.ajem.2020.11.029. google scholar
• 48. Isba R, Edge R, Auerbach M, Cicero MX, Jenner R, Setzer E, et al. COVID-19: Transatlantic declines in pediatric emergency admissions. Pediatr Emerg Care 2020;36(11):551-3. doi:10.1097/ PEC.0000000000002260. google scholar
• 49. Sharma S, Wong D, Schomberg J, Robins CK, Gibbs D, Berkowitz C, et al. COVID-19: Differences in sentinel injury and child abuse reporting during a pandemic. Child Abus Negl 2021;116:104990. doi:10.1016/j.chiabu.2021.104990. google scholar
• 50. World Health Organization. Addressing violence against children, women and older people during the COVID-19 pandemic: Key actions. World Health Organ 2020;(June):1-7. google scholar
• 51. Rosenthal CM, Thompson LA. Child abuse awareness month during the coronavirus disease 2019 pandemic. JAMA Pediatr 2020;174(8):812. doi:10.1001/jamapediatrics.2020.1459. google scholar
• 52. Raman S, Harries M, Nathawad R, Kayeremateng R, Seth R, Lonne B, et al. Where do we go from here? A child rights-based response to COVID-19. BMJ Paediatr Open 2020;4(1). doi:10.1136/ bmjpo-2020-000714. google scholar
• 53. Baron EJ, Goldstein EG, Wallace CT. Suffering in silence: How COVID- 19 school closures inhibit the reporting of child maltreatment. J Public Econ 2020;190:104258. doi:10.1016/j. jpubeco.2020.104258. google scholar
• 54. McNally VV, Bernstein HH. The effect of the COVID-19 pandemic on childhood immunizations: Ways to strengthen routine vaccination. Pediatr Ann 2020;49(12):e516-22. doi:10.3928/19382359-20201115-01. google scholar
• 55. Wimberly CE, Towry L, Caudill C, Johnston EE, Walsh KM. Impacts of COVID 19 on caregivers of childhood cancer survivors. Pediatr Blood Cancer 2021;68(4):e28943. doi:10.1002/pbc.28943. google scholar
• 56. Atout M, Tarawneh FS, Al-Kharabsheh A. Challenges faced by mothers caring for children with leukaemia during COVID-19 pandemic: A qualitative study. J Pediatr Nurs 2021;58:e74-e80. doi:10.1016/j.pedn.2021.01.009. google scholar
• 57. Elbarbary NS, dos Santos TJ, de Beaufort C, Agwu JC, Calliari LE, Scaramuzza AE. COVID-19 outbreak and pediatric diabetes: Perceptions of health care professionals worldwide. Pediatr Diabetes 2020;21(7):1083-92. doi:10.1111/pedi.13084. google scholar
• 58. Odeh R, Gharaibeh L, Daher A, Kussad S, Alassaf A. Caring for a child with type 1 diabetes during COVID-19 lockdown in a developing country: Challenges and parents’ perspectives on the use of telemedicine. Diabetes Res Clin Prac 2020;168:108393. doi:10.1016/j.diabres.2020.108393. google scholar
• 59. Graetz D, Agulnik A, Ranadive R, Vedaraju Y, Chen Y, Chontada G, et al. Global effect of the COVID-19 pandemic on paediatric cancer care: a cross-sectional study. Lancet Child Adolesc Heal 2021;5(5):332-40. doi:10.1016/s2352-4642(21)00031-6. google scholar
• 60. Galloway DP, Mathis MS, Wilkinson LT, Venick RS, Wendel D, Cole CR, et al. Effect of the COVID-19 Pandemic on Pediatric Intestinal Failure Healthcare Delivery. J Parenter Enter Nutr 2021;45(1):50-6. doi:10.1002/jpen.2000. google scholar
• 61. Fisher JC, Tomita SS, Ginsburg HB, Gordon A, Walker D, Kuenzler KA. Increase in pediatric perforated appendicitis in the New York City metropolitan region at the epicenter of the COVID-19 outbreak. Ann Surg 2021;273(3):410-5. doi:10.1097/SLA.0000000000004426. google scholar
• 62. Ördek E, Demir M, Yağmur İ. Evaluation of the impact of COVID-19 pandemia on pediatric urological operations and the number of outpatient clinic patients in a province with, the highest birth rate Turkey. Pamukkale Med J 2021;14(3):632-7. doi:10.31362/ patd.895126. google scholar
• 63. Witt A, Ordonez A, Martin A, Vitiello B, Fegert JM. Child and adolescent mental health service provision and research during the Covid-19 pandemic: Challenges, opportunities, and a call for submissions. Child Adolesc Psychiatry Ment Health 2020;14(1). doi:10.1186/s13034-020-00324-8. google scholar
• 64. Fegert JM, Vitiello B, Plener PL, Clemens V. Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: A narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child Adolesc Psychiatry Ment Health 2020;14(1):20. doi:10.1186/s13034-020-00329-3. google scholar
• 65. Racine N, Hartwick C, Collin-Vezina D, Madigan S. Telemental health for child trauma treatment during and post-COVID-19: Limitations and considerations. Child Abus Negl 2020;110:104698. doi:10.1016/j.chiabu.2020.104698. google scholar
• 66. Bulucu Büyüksoy GD, Özdil K, Çatiker A. Pandemisinde 6-12 yaş arası çocuklarda karşılanmamış sağlık hizmeti gereksinimleri. Halk Sağlığı Hemşireliği Derg 2021;3(1):4-17. google scholar
• 67. Young Minds. Coronavirus: Impact on young people with mental health needs Survey 2: Summer 2020. YoungMinds. Published 2020. Erişim 9 Haziran 2021. https://youngminds.org.uk/about-us/ media-centre/press-releases/coronavirus-having-major-impact-on-young-people-with-mental-health-needs-new- survey/. google scholar
• 68. Swansburg R, Hai T, MacMaster FP, Lemay J-F. Impact of COVID-19 on lifestyle habits and mental health symptoms in children with attention-deficit/hyperactivity disorder in Canada. Paediatr Child Health 2021;2021:1-9. doi:10.1093/pch/pxab030. google scholar
• 69. Krasovsky T, Silberg T, Barak S, Eisenstein E, Erez N, Feldman I, et al. Transition to multidisciplinary pediatric telerehabilitation during the covid-19 pandemic: Strategy development and implementation. Int J Environ Res Public Health 2021;18(4):1-13. doi:10.3390/ijerph18041484. google scholar
• 70. Jeste S, Hyde C, Distefano C, Halladay A, Ray S, Porath M, et al. Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID-19 restrictions. J Intellect Disabil Res 2020;64(11):825-33. doi:10.1111/jir.12776. google scholar
• 71. Bova SM, Basso M, Bianchi MF, Savare L, Ferrara G, Mura E, et al. Impact of COVID-19 lockdown in children with neurological disorders in Italy. Disabil Health J 2021;14(2):101053. doi:10.1016/j.dhjo.2020.101053. google scholar