2101
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Cohen-Kfir N, Bentwich ME, Kent A, Dickman N, Tanus M, Higazi B, Kalfon L, Rudolf M, Falik-Zaccai TC. Challenges to effective and autonomous genetic testing and counseling for ethno-cultural minorities: a qualitative study. BMC Med Ethics 2020; 21:98. [PMID: 33059675 PMCID: PMC7565773 DOI: 10.1186/s12910-020-00537-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background The Arab population in Israel is a minority ethnic group with its own distinct cultural subgroups. Minority populations are known to underutilize genetic tests and counseling services, thereby undermining the effectiveness of these services among such populations. However, the general and culture-specific reasons for this underutilization are not well defined. Moreover, Arab populations and their key cultural-religious subsets (Muslims, Christians, and Druze) do not reside exclusively in Israel, but are rather found as a minority group in many European and North American countries. Therefore, focusing on the Arab population in Israel allows for the examination of attitudes regarding genetic testing and counseling among this globally important ethnic minority population. Methods We used a qualitative research method, employing individual interviews with 18 women of childbearing age from three religious subgroups (i.e., Druze, Muslim, and Christian) who reside in the Acre district, along with focus group discussions with healthcare providers (HCPs; 9 nurses and 7 genetic counselors) working in the same geographical district. Results A general lack of knowledge regarding the goals and practice of genetic counseling resulting in negative preconceptions of genetic testing was identified amongst all counselees. Counselors’ objective of respecting patient autonomy in decision-making, together with counselees’ misunderstanding of genetic risk data, caused uncertainty, frustration, and distrust. In addition, certain interesting variations were found between the different religious subgroups regarding their attitudes to genetic counseling. Conclusions The study highlights the miscommunications between HCPs, particularly counselors from the majority ethno-cultural group, and counselees from a minority ethno-cultural group. The need for nuanced understanding of the complex perspectives of minority ethno-cultural groups is also emphasized. Such an understanding may enhance the effectiveness of genetic testing and counseling among the Arab minority group while also genuinely empowering the personal autonomy of counselees from this minority group in Israel and other countries.
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Affiliation(s)
- Nehama Cohen-Kfir
- The Azrieli Faculty of Medicine, Bar Ilan University, 8 Henrietta Szold St, P.O. Box 1589, Safed, Israel.,The Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel
| | - Miriam Ethel Bentwich
- The Azrieli Faculty of Medicine, Bar Ilan University, 8 Henrietta Szold St, P.O. Box 1589, Safed, Israel.
| | - Andrew Kent
- Division of Hematology and Oncology, University of Colorado Hospital, Aurora, Colorado, USA
| | - Nomy Dickman
- The Azrieli Faculty of Medicine, Bar Ilan University, 8 Henrietta Szold St, P.O. Box 1589, Safed, Israel
| | - Mary Tanus
- Israeli Ministry of Health, Akko District, Acre, New York, USA
| | - Basem Higazi
- The Azrieli Faculty of Medicine, Bar Ilan University, 8 Henrietta Szold St, P.O. Box 1589, Safed, Israel
| | - Limor Kalfon
- The Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel
| | - Mary Rudolf
- The Azrieli Faculty of Medicine, Bar Ilan University, 8 Henrietta Szold St, P.O. Box 1589, Safed, Israel
| | - Tzipora C Falik-Zaccai
- The Azrieli Faculty of Medicine, Bar Ilan University, 8 Henrietta Szold St, P.O. Box 1589, Safed, Israel.,The Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel
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2102
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Chang JCJ, Hwang SJ, Chen TJ, Chiu TY, Yang HY, Chen YC, Huang CK, Jan CF. Team-based care improves quality of diabetes care -Family Practice Integrated Care Project in Taiwan. BMC FAMILY PRACTICE 2020; 21:209. [PMID: 33059587 PMCID: PMC7561235 DOI: 10.1186/s12875-020-01284-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 10/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Family Practice Integrated Care Project (FPICP) is a team-based program in Taiwan initiated in 2003. This study investigates the influence of FPICP on the quality of diabetes care. METHODS This population-based cohort study used Taiwan's National Health Insurance Administration data on FPICP (fiscal year 2015-2016, with follow-up duration of one year). Participants included diabetic patients aged ≥30 in primary care clinics. We used conditional logistic regression modeling of patient characteristics and annual diabetes examinations and compared FPICP participants with non-participating candidates. Main outcome measures included completion of annual diabetes examinations, including glycated hemoglobin (A1c), low-density lipoprotein (LDL), urine microalbumin (MAU), routine urinalysis (UR), and fundus examination (FE). RESULTS The sample included 298,208 FPICP participants and 478,778 non-participating candidates. After 1:1 propensity score matching, the examination completion rates for FPICP participants and non-participants, respectively, were 94.4% versus 93.6% in A1c, 84.2% versus 83.8% in LDL, 61.9% versus 60.1% in MAU, 59.2% versus 58.0% in UR, and 30.1% versus 32.4% in FE. CONCLUSION Our findings indicate that a program like FPICP helps improve the quality of diabetes care through regular examinations of Alc, LDL, MAU, and UR.
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Affiliation(s)
- Jerry Che-Jui Chang
- Department of Family Medicine, National Taiwan University Hospital, No. 17 Xuzhou Road, Taipei, 100, Taiwan
- Taiwan Medical Association, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Taiwan Association of Family Medicine, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Taiwan Association of Family Medicine, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, National Taiwan University Hospital, No. 17 Xuzhou Road, Taipei, 100, Taiwan
- Taiwan Medical Association, Taipei, Taiwan
| | - Hsiao-Yu Yang
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chun Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Cheng-Kuo Huang
- Taiwan Association of Family Medicine, Taipei, Taiwan
- Dr. Cheng-Kuo Huang Clinic, Keelung, Taiwan
| | - Chyi-Feng Jan
- Department of Family Medicine, National Taiwan University Hospital, No. 17 Xuzhou Road, Taipei, 100, Taiwan.
- Taiwan Association of Family Medicine, Taipei, Taiwan.
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2103
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Quan XQ, Xu C, Wang RC, Zhang CT, Zhang Q, Zhou HL. The relationship between Chlamydia pneumoniae infection and CD4/CD8 ratio, lymphocyte subsets in middle-aged and elderly individuals. Microb Pathog 2020; 149:104541. [PMID: 33068732 DOI: 10.1016/j.micpath.2020.104541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 04/19/2020] [Accepted: 09/28/2020] [Indexed: 12/21/2022]
Abstract
Chlamydia pneumoniae (C. pneumoniae) is a common respiratory pathogen associated with many inflammatory diseases. There are few data concerning the lymphocyte subsets in middle-aged and elderly individuals with C. pneumoniae infection. A total of 191 patients were included in this study. The study population was categorized into the middle-aged group (40-64 years old) and the elderly group (65-89 years old). Lymphocyte subsets in peripheral blood were examined with multi-colored flow cytometry. Immunological monitoring included lymphocyte subsets, C. pneumoniae IgG and IgM serology. In the middle-aged group, 69.83% individuals presented IgG positivity, which was associated with the inverted CD4/CD8 ratio. Individuals with C. pneumoniae IgG positivity also presented an increased percentage of CD8+CD28- cells and a decreased CD4/CD8 ratio when compared to weakly-positive individuals. In the elderly group, C. pneumoniae IgG positivity was associated with a significant increase in the percentage of CD3+CD56+CD45+ (NKT) cells. In conclusion, altered lymphocyte homeostasis was shown in middle-aged individuals with C. pneumoniae IgG positivity. The senescent phenotypes of T cells might be associated with C. pneumoniae infection in middle-aged individuals.
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Affiliation(s)
- Xiao-Qing Quan
- Department of General Pratice, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, China
| | - Chang Xu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Run-Chang Wang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Cun-Tai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Qing--
| | - Hong-Lian Zhou
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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2104
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Batchelor M, Maguire S, Shearn J. "They just get it" an exploration of father's experiences and perceptions of a support group for men caring for children with disabilities and/or developmental delay. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:263-273. [PMID: 33047415 DOI: 10.1111/jar.12804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 07/29/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Support groups available to parents/carers of children with a disability or developmental delay (DDD) are predominately attended by women. Limited data exists reporting experiences of the few male-only support groups. This paper examines experiences of fathers of children with DDD attending a male-only support group from South Wales. METHOD All fifteen members from a support group for fathers/male carers of children with DDD were invited to take part in qualitative interviews and seven participated. The data were analysed following Braun and Clarke's (Qualitative research in psychology, 2006, 3:77) thematic framework. RESULTS Within the group, fathers felt understood by similarly situated men, and a sense of connectivity and belonging. Fathers perceived exclusion elsewhere, including mixed-gender groups. Fathers felt permission to talk in a way consistent with their male identities, and valued receiving, and giving, support. CONCLUSIONS Mixed-gender support groups may not meet the needs of fathers, and there are potential benefits in providing male-only groups.
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Affiliation(s)
- Molly Batchelor
- Child and Family Psychological Health Service, Family and Therapy Services Division, Caerleon, UK.,Sparkle (South Wales) Ltd, Serennu Children's Centre, Newport, UK
| | | | - Julia Shearn
- Sparkle (South Wales) Ltd, Serennu Children's Centre, Newport, UK
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2105
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Alsufyani AM, Alforihidi MA, Almalki KE, Aljuaid SM, Alamri AA, Alghamdi MS. Linking the Saudi Arabian 2030 vision with nursing transformation in Saudi Arabia: Roadmap for nursing policies and strategies. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020; 13:100256. [PMID: 33072514 PMCID: PMC7553899 DOI: 10.1016/j.ijans.2020.100256] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 11/04/2022] Open
Abstract
The Saudi government is currently facing multiple challenges in achieving "The Gold Standard" in nursing practice. This is not limited to educational challenges, staffing shortage, paucity of international and national benchmark evidence, absence of clear and defined scope of nursing practice, and lack of appropriate policies and regulations. This study presented a comprehensive plan for developing a policy based on current challenges, recognition of policy goals, assessment of potential options and alternatives, identification of stakeholders, proposition of recommended solutions, and implementation of the framework to transform nursing standards and link these changes with the Saudi Vision 2030. However, amendments are required in the present strategic plan for the better management of the nursing profession. It is doubtful that the current nursing profession status quo is capable of meeting the golden standards for health care. Thus, the transformation of the nursing profession in Saudi Arabia is necessary.
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Affiliation(s)
- Abdulaziz M Alsufyani
- College of Nursing, King Saud University, Riyadh, Saudi Arabia
- Ministry of Human Resources and Social Development, Saudi Arabia
| | | | | | - Sayer M Aljuaid
- Ministry of Human Resources and Social Development, Saudi Arabia
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2106
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Mohamed Ahmed E, Chen EP. Perspectives of Surgeons from Atlanta, USA. J Card Surg 2020; 36:1693-1695. [PMID: 33058270 DOI: 10.1111/jocs.15098] [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: 09/07/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The COVID-19 pandemic in late 2019 quickly stretched health care system across the globe. Mortalities, shortages in health care system capacity, and lack of experience in similar circumstances required innovation in the way health care is delivered. Health care systems changed operating schedules, staff work pattern, and how patients are cared for. The effects of these changes reached patients, staff and training in different ways. METHODS We searched the Pubmed and EMBASE for articles related to COVID-19. We also searched local emails and information provided to staff during the pandemic RESULTS: The COVID-19 pandemic affected organizations, patients, and staff. The organizations and staff had to adapt to the times to provide a safe and appropriate service to our patients. CONCLUSION The pandemic challenged and changed the way we work as health care providers, and how we train the future surgeons. Changes in the system were effective.
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Affiliation(s)
- Eltayeb Mohamed Ahmed
- Division of Cardiothoracic Surgery, Department of Surgery, Emory School of Medicine, Atlanta, Georgia, USA
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory School of Medicine, Atlanta, Georgia, USA
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2107
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Positive association between systemic immune-inflammatory index and mortality of cardiogenic shock. Clin Chim Acta 2020; 511:97-103. [PMID: 33045194 DOI: 10.1016/j.cca.2020.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cardiogenic shock (CGS) is not only a state of hypoperfusion, but also related to inflammation. The prognostic value of systemic immune-inflammatory index (SII), an innovate biomarker of inflammation, in CGS patients has not been assessed. This study aims to explore the associations between SII and mortality in patients with CGS. METHODS Data on patients diagnosed with CGS were extracted from MIMIC-III database version 1.4. The follow-up started on the patients' first admission to ICU. The primary outcome was 30-day mortality. 90-day and 365-day mortality were the secondary outcomes. Cox proportional hazards models were used to investigate the associations between SII and mortality of CGS patients. RESULTS 707 patients with CGS were included in our study (59.8% male, 67.5% the white, 70.27 ± 14.56 years). For 30-day mortality, the HR (95% CI) value of high-SII group was 2.17 (1.60, 2.93) compared with the reference of low-SII group (P < 0.0001). The HR value of mid-SII group, however, showed none statistical significance (HR: 1.03, 95% CI: 0.74-1.43, P = 0.8516). When adjusted for age, gender and ethnicity in Model I, the adjusted HR (95% CI) value of high-SII group was 2.28 (1.69, 3.09). When further adjusted for heart rate, SBP, serum potassium, PTT, INR and ECI in Model II, the adjusted HR value of high-SII group was still statistically significant (HR: 2.08, 95% CI: 1.52-2.86, P < 0.0001). Similar results were also shown in the secondary outcomes of 90-day and 365-day mortality. CONCLUSIONS High level of SII is associated with increased short- and long-term mortality of patients with CGS. SII, a readily available biomarker, can independently predict the prognosis of CGS patients.
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2108
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Koh WC, Naing L, Chaw L, Rosledzana MA, Alikhan MF, Jamaludin SA, Amin F, Omar A, Shazli A, Griffith M, Pastore R, Wong J. What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors. PLoS One 2020; 15:e0240205. [PMID: 33031427 PMCID: PMC7544065 DOI: 10.1371/journal.pone.0240205] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case. METHODS We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test. RESULTS 43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%). DISCUSSION While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.
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Affiliation(s)
- Wee Chian Koh
- Centre for Strategic and Policy Studies, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Muhammad Ali Rosledzana
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Mohammad Fathi Alikhan
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Sirajul Adli Jamaludin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Faezah Amin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Asiah Omar
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Alia Shazli
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Matthew Griffith
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Roberta Pastore
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Justin Wong
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
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2109
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Koh WC, Naing L, Chaw L, Rosledzana MA, Alikhan MF, Jamaludin SA, Amin F, Omar A, Shazli A, Griffith M, Pastore R, Wong J. What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors. PLoS One 2020; 15:e0240205. [PMID: 33031427 DOI: 10.1101/2020.05.21.20108746] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case. METHODS We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test. RESULTS 43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%). DISCUSSION While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.
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Affiliation(s)
- Wee Chian Koh
- Centre for Strategic and Policy Studies, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Muhammad Ali Rosledzana
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Mohammad Fathi Alikhan
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Sirajul Adli Jamaludin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Faezah Amin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Asiah Omar
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Alia Shazli
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Matthew Griffith
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Roberta Pastore
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Justin Wong
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
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2110
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Trankle SA, Usherwood T, Abbott P, Roberts M, Crampton M, Girgis CM, Riskallah J, Chang Y, Saini J, Reath J. Key stakeholder experiences of an integrated healthcare pilot in Australia: a thematic analysis. BMC Health Serv Res 2020; 20:925. [PMID: 33028299 PMCID: PMC7542969 DOI: 10.1186/s12913-020-05794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally. METHODS We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n = 42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts. RESULTS Key themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting. CONCLUSIONS Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.
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Affiliation(s)
- Steven A Trankle
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Tim Usherwood
- Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), Sydney, Australia
- George Institute for Global Health, Sydney, Australia
| | - Penelope Abbott
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Mary Roberts
- Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), Sydney, Australia
| | | | - Christian M Girgis
- Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | - John Riskallah
- Western Sydney Local Health District (Blacktown Hospital), Sydney, Australia
| | - Yashu Chang
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
- Western Sydney Local Health District (Blacktown Hospital), Sydney, Australia
| | - Jaspreet Saini
- Western Sydney Primary Health Network, Sydney, Australia
| | - Jennifer Reath
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Latkin C, Dayton L, Strickland JC, Colon B, Rimal R, Boodram B. An Assessment of the Rapid Decline of Trust in US Sources of Public Information about COVID-19. JOURNAL OF HEALTH COMMUNICATION 2020; 25:764-773. [PMID: 33719879 PMCID: PMC7968001 DOI: 10.1080/10810730.2020.1865487] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We conducted a longitidinal assessment of 806 respondents in March, 2020 in the US to examine the trustworthiness of sources of information about COVID-19. Respondents were recontacted after four months. Information sources included mainstream media, state health departments, the CDC, the White House, and a well-known university. We also examined how demographics, political partisanship, and skepticism about COVID-19 were associated with the perceived trustworthiness of information sources and decreased trustworthiness over time. At baseline, the majority of respondants reported high trust in COVID-19 information from state health departments (75.6%), the CDC (80.9%), and a university (Johns Hopkins, 81.1%). Mainstream media was trusted by less than half the respondents (41.2%), and the White House was the least trusted source (30.9%). At the 4-month follow-up, a significant decrease in trustworthiness in all five sources of COVID-19 information was observed. The most pronounced reductions were from the CDC and the White House. In multivariate analyses, factors associated with rating the CDC, state health department, and a university as trustworthy sources of COVID-19 information were political party affiliation, level of education, and skepticism about COVID-19. The most consistent predictor of decreased trust was political party affiliation, with Democrats as compared to Republicans less likely to report decreased trust across all sources.
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Affiliation(s)
- Carl Latkin
- Department of Health, Behavior and Society, Bloomberg
School of Public Health, Johns Hopkins University
| | - Lauren Dayton
- Department of Health, Behavior and Society, Bloomberg
School of Public Health, Johns Hopkins University
| | - Justin C. Strickland
- Behavioral Pharmacology Research Unit, Department of
Psychiatry and Behavioral Sciences, Johns Hopkins University School of
Medicine
| | - Brian Colon
- Krieger School of Arts & Sciences, Johns Hopkins
University
| | - Rajiv Rimal
- Department of Health, Behavior and Society, Bloomberg
School of Public Health, Johns Hopkins University
| | - Basmattee Boodram
- Division of Community Health Sciences, University of
Illinois at Chicago School of Public Health, Chicago, IL
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2112
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Abstract
OBJECTIVES To understand how individuals with tinnitus perceive their sound generating devices help them in managing their tinnitus. DESIGN A qualitative interview based study employing grounded theory methodology to establish a theory as to the mechanisms that sound therapies contribute to coping with tinnitus. Ten National Health Service patient participants (who had been issued with sound generating devices from an Audiology department in England) participated in in depth interviews. RESULTS This study identified that sound therapies helped create a sense of escapism and control. In addition, the process of obtaining devices created a sense of validation of the patient and their tinnitus. These mechanisms restore the previously disrupted harmony between the self and body. CONCLUSION Sound generating devices can assist coping through a number of mechanisms. There is no evidence that they ablate or remove perception of tinnitus. This study contributes novel theory based on patient accounts as to the potential benefits of sound generating device use.
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Affiliation(s)
- Shameela Munir
- Audiology department, School of Life and Health Sciences, Aston University, Birmingham, UK.,Centre of Hearing and Balance Disorders, University Hospital, Coventry, UK
| | - Helen Pryce
- Audiology department, School of Life and Health Sciences, Aston University, Birmingham, UK
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2113
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'You're not just a medical professional': Exploring paramedic experiences of overdose response within Vancouver's downtown eastside. PLoS One 2020; 15:e0239559. [PMID: 32986736 PMCID: PMC7521748 DOI: 10.1371/journal.pone.0239559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Overdose response has become an increasingly relevant component of paramedic practice, particularly in light of increased opioid overdose globally. Previous studies have noted gaps in our understanding regarding the unique challenges which paramedics face during this form of pre-hospital emergency care. The aim of this study is to explore and describe the ways in which paramedics experience overdose response, specifically within a community markedly affected by the overdose crisis. METHODS Ten participants were recruited from a single ambulance station located in an urban center in Western Canada. Two rounds of semi-structured individual interviews were conducted, and data saturation was found to have been reached. Verbatim transcripts were produced and subject to two rounds of descriptive and pattern coding. A second researcher reviewed all of the codes, with disagreements being handled by discussion until agreement was obtained. Themes were identified, along with a Core Category which seeks to describe the underlying dynamics of overdose response represented in our data. The concept of a Core Category was borrowed from Grounded Theory methodology. FINDINGS Five major themes were identified: Connecting with patients' lived experiences; Occupying roles as clinicians and patient advocates; Navigating on-scene hazards; Difficulties with transitions of care; and Emotional burden of the overdose crisis. A core category was identified as One's capacity to help. CONCLUSIONS This research contributes to existing literature on overdose response by specifically examining paramedic experiences during this form of emergency care. While paramedics felt highly confident in providing clinical care, their capacity to address underlying causes of drug use was understood as much more limited. Participants found ways to address this lack of control, along with feelings of frustration, by trying to understand patient perspectives and adopting empathetic attitudes.
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2114
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Dios-Quiroga F, Soliño-Lourido S, Pallas-Queijo C, González-Formoso C, Constenla-Castro A, Conde-Freire S, Clavería A. Multidimensional Geriatric Assessment with MAGIC Questionnaire and Quality of Life in Elderly Primary Care Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197089. [PMID: 32998200 PMCID: PMC7579506 DOI: 10.3390/ijerph17197089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022]
Abstract
The Manageable Geriatric Assessment (MAGIC) questionnaire, recently developed by a group of European family doctors for multidimensional geriatric assessment in primary care, has not yet been evaluated in clinical practice. The objectives of this study were to translate and adapt it to Spanish and to check the association between the limitations of older adults identified by this questionnaire and their perceived health status assessed by the five-level version of the EuroQol-5D (EQ-5D-5L). First, questionnaire translation, back translation and cognitive test were applied. Then, a cross-sectional observational study was performed in two Spanish health centers Galicia, Spain. Participants were 170 people aged over 75, recruited opportunistically by consecutive case sampling. Anonymous surveys were used to collect data. The MAGIC questionnaire, the EQ-5D-5L scale, age and sex were employed. The visual analog scale of EQ-5D-5L (EQ VAS) was used as the outcome variable. Descriptive and bivariate analyses by sex and outcome variable are presented. The linear regression analysis showed an association with quality of life for daily activities, recognizing people and stress incontinence. As this is associated with quality of life, the MAGIC questionnaire may be useful in primary care and a study to investigate the impact on health with a clinical trial would be worth considering.
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Affiliation(s)
- Fátima Dios-Quiroga
- Quality and Research Unit, Health Area of Vigo, Galician Health Service, RedIAPP, Group I-Saúde (Institute of Health Research Galicia Sur), CP 36201 Vigo, Spain;
- Correspondence: ; Tel.: +67-885-7799
| | - Susana Soliño-Lourido
- Lérez Health Center, Lugar Porta do Sol s/n, Health Area of Pontevedra, CP 36156 Pontevedra, Spain; (S.S.-L.); (A.C.-C.)
| | - Carmen Pallas-Queijo
- Vigo Family and Community Medicine and Nursing Teaching Unit, Health Area of Vigo, Galician Health Service, RedIAPP, Group I-Saúde (Institute of Health Research Galicia Sur), CP 36201 Vigo, Spain; (C.P.-Q.); (C.G.-F.)
| | - Clara González-Formoso
- Vigo Family and Community Medicine and Nursing Teaching Unit, Health Area of Vigo, Galician Health Service, RedIAPP, Group I-Saúde (Institute of Health Research Galicia Sur), CP 36201 Vigo, Spain; (C.P.-Q.); (C.G.-F.)
| | - Aurelia Constenla-Castro
- Lérez Health Center, Lugar Porta do Sol s/n, Health Area of Pontevedra, CP 36156 Pontevedra, Spain; (S.S.-L.); (A.C.-C.)
| | - Soledad Conde-Freire
- Val Miñor Health Center, Avenida Portugal, 91 (A Xunqueira)—A Ramallosa, Health Area of Vigo, CP 36379 Pontevedra, Spain;
| | - Ana Clavería
- Quality and Research Unit, Health Area of Vigo, Galician Health Service, RedIAPP, Group I-Saúde (Institute of Health Research Galicia Sur), CP 36201 Vigo, Spain;
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2115
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Social networks, health and identity: exploring culturally embedded masculinity with the Pakistani community, West Midlands, UK. BMC Public Health 2020; 20:1432. [PMID: 32957934 PMCID: PMC7507824 DOI: 10.1186/s12889-020-09504-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Migrants from South Asia living in developed countries have an increased risk for developing cardiovascular disease (CVD), with limited research into underlying social causes. Methods We used social capital as an interpretive lens to undertake analysis of exploratory qualitative interviews with three generations of at-risk migrant Pakistani men from the West Midlands, UK. Perceptions of social networks, trust, and cultural norms associated with access to healthcare (support and information) were the primary area of exploration. Results Findings highlighted the role of social networks within religious or community spaces embedded as part of ethnic enclaves. Local Mosques and gyms remained key social spaces, where culturally specific gender differences played out within the context of a diaspora community, defined ways in which individuals navigated their social spheres and influenced members of their family and community on health and social behaviours. Conclusions There are generational and age-based differences in how members use locations to access and develop social support for particular lifestyle choices. The pursuit of a healthier lifestyle varies across the diverse migrant community, determined by social hierarchies and socio-cultural factors. Living close to similar others can limit exposure to novel lifestyle choices and efforts need to be made to promote wider integration between communities and variety of locations catering to health and lifestyle.
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2116
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Bagonza A, Peterson S, Mårtensson A, Wamani H, Awor P, Mutto M, Musoke D, Gibson L, Kitutu FE. Regulatory inspection of registered private drug shops in East-Central Uganda-what it is versus what it should be: a qualitative study. J Pharm Policy Pract 2020; 13:55. [PMID: 32944257 PMCID: PMC7488315 DOI: 10.1186/s40545-020-00265-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022] Open
Abstract
Background Regulatory inspection of private drug shops in Uganda is a mandate of the Ministry of Health carried out by the National Drug Authority. This study evaluated how this mandate is being carried out at national, district, and drug shop levels. Specifically, perspectives on how the inspection is done, who does it, and challenges faced were sought from inspectors and drug sellers. Methods Six key informant interviews (KIIs) were held with inspectors at the national and district level, while eight focus group discussions (FGDs) were conducted among nursing assistants, and two FGDs were held with nurses. The study appraised current methods of inspecting drug sellers against national professional guidelines for licensing and renewal of class C drug shops in Uganda. Transcripts were managed using Atlas ti version 7 (ATLAS.ti GmbH, Berlin) data management software where the thematic content analysis was done. Results Five themes emerged from the study: authoritarian inspection, delegated inspection, licensing, training, and bribes. Under authoritarian inspection, drug sellers decried the high handedness used by inspectors when found with expired or no license at all. For delegated inspection, drug sellers said that sometimes, inspectors send health assistants and sub-county chiefs for inspection visits. This cadre of people is not recognized by law as inspectors. Inspectors trained drug sellers on how to organize their drug shops better and how to use new technologies such as rapid diagnostic tests (RDTs) in diagnosing malaria. Bribes were talked about mostly by nursing assistants who purported that inspectors were not interested in inspection per se but collecting illicit payments from them. Inspectors said that the facilitation they received from the central government were inadequate for a routine inspection. Conclusion The current method of inspecting drug sellers is harsh and instills fear among drug sellers. There is a need to establish a well-recognized structure of inspection as well as establish channels of dialogue between inspectors and drug sellers if meaningful compliance is to be achieved. The government also needs to enhance both human and financial resources if meaningful inspection of drug sellers is to take place.
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Affiliation(s)
- Arthur Bagonza
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stefan Peterson
- Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.,International Maternal and Child Health Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Andreas Mårtensson
- International Maternal and Child Health Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Henry Wamani
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Phyllis Awor
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Milton Mutto
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Linda Gibson
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Freddy Eric Kitutu
- Department of Pharmacy, School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
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2117
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Fridman S, Bres Bullrich M, Jimenez-Ruiz A, Costantini P, Shah P, Just C, Vela-Duarte D, Linfante I, Sharifi-Razavi A, Karimi N, Bagur R, Debicki DB, Gofton TE, Steven DA, Sposato LA. Stroke risk, phenotypes, and death in COVID-19: Systematic review and newly reported cases. Neurology 2020; 95:e3373-e3385. [PMID: 32934172 DOI: 10.1212/wnl.0000000000010851] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To investigate the hypothesis that strokes occurring in patients with coronavirus disease 2019 (COVID-19) have distinctive features, we investigated stroke risk, clinical phenotypes, and outcomes in this population. METHODS We performed a systematic search resulting in 10 studies reporting stroke frequency among patients with COVID-19, which were pooled with 1 unpublished series from Canada. We applied random-effects meta-analyses to estimate the proportion of stroke among COVID-19. We performed an additional systematic search for cases series of stroke in patients with COVID-19 (n = 125), and we pooled these data with 35 unpublished cases from Canada, the United States, and Iran. We analyzed clinical characteristics and in-hospital mortality stratified into age groups (<50, 50-70, >70 years). We applied cluster analyses to identify specific clinical phenotypes and their relationship with death. RESULTS The proportions of patients with COVID-19 with stroke (1.8%, 95% confidence interval [CI] 0.9%-3.7%) and in-hospital mortality (34.4%, 95% CI 27.2%-42.4%) were exceedingly high. Mortality was 67% lower in patients <50 years of age relative to those >70 years of age (odds ratio [OR] 0.33, 95% CI 0.12-0.94, p = 0.039). Large vessel occlusion was twice as frequent (46.9%) as previously reported and was high across all age groups, even in the absence of risk factors or comorbid conditions. A clinical phenotype characterized by older age, a higher burden of comorbid conditions, and severe COVID-19 respiratory symptoms was associated with the highest in-hospital mortality (58.6%) and a 3 times higher risk of death than the rest of the cohort (OR 3.52, 95% CI 1.53-8.09, p = 0.003). CONCLUSIONS Stroke is relatively frequent among patients with COVID-19 and has devastating consequences across all ages. The interplay of older age, comorbid conditions, and severity of COVID-19 respiratory symptoms is associated with an extremely elevated mortality.
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Affiliation(s)
- Sebastian Fridman
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Maria Bres Bullrich
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Amado Jimenez-Ruiz
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Pablo Costantini
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Palak Shah
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Caroline Just
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Daniel Vela-Duarte
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Italo Linfante
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Athena Sharifi-Razavi
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Narges Karimi
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Rodrigo Bagur
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Derek B Debicki
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Teneille E Gofton
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - David A Steven
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Luciano A Sposato
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada.
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2118
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Fernández-Martínez E, Abreu-Sánchez A, Pérez-Corrales J, Ruiz-Castillo J, Velarde-García JF, Palacios-Ceña D. Living with Pain and Looking for a Safe Environment: A Qualitative Study among Nursing Students with Dysmenorrhea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6670. [PMID: 32933209 PMCID: PMC7558082 DOI: 10.3390/ijerph17186670] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022]
Abstract
Dysmenorrhea refers to chronic pain associated with menstruation that is often accompanied by other symptoms. Primary dysmenorrhea (PD) occurs without any associated pelvic disease. Nonetheless, it may negatively affect women's quality of life. Among university students, dysmenorrhea decreases academic performance and is a cause of absenteeism. The purposes of our study were to describe how nursing students experienced PD and the changes affecting their body and mood. A qualitative case study was performed among 33 nursing students with PD. Data were collected through five focus groups (with two sessions each) and 10 researchers' field notes. We used a video meeting platform to conduct the focus groups. A thematic analysis was performed, and the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research guidelines were followed. Three main themes emerged from the data: (a) living with dysmenorrhea, with two subthemes: menstruation and pain; (b) body changes and mood swings; and (c) seeking a safe environment, with three subthemes: safe environment, unsafe environment, and key safety aspects. Students considered menstruation to be negative and limiting, causing physical and mood changes, making them feel less attractive, and conditioning their way of dressing and relating.
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Affiliation(s)
- Elia Fernández-Martínez
- Department of Nursing, University of Huelva, Avenida Tres de Marzo s/n, 21071 Huelva, Spain; (E.F.-M.); (A.A.-S.); (J.R.-C.)
| | - Ana Abreu-Sánchez
- Department of Nursing, University of Huelva, Avenida Tres de Marzo s/n, 21071 Huelva, Spain; (E.F.-M.); (A.A.-S.); (J.R.-C.)
| | - Jorge Pérez-Corrales
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Avenida Atenas s/n, 28922 Alcorcón, Spain;
| | - Javier Ruiz-Castillo
- Department of Nursing, University of Huelva, Avenida Tres de Marzo s/n, 21071 Huelva, Spain; (E.F.-M.); (A.A.-S.); (J.R.-C.)
| | - Juan Francisco Velarde-García
- Department of Nursing, Red Cross College, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Autónoma de Madrid, Calle Reina Victoria 28, 28003 Madrid, Spain;
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Avenida Atenas s/n, 28922 Alcorcón, Spain;
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2119
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Hao HS, Gao H, Li T, Zhang D. Assessment and Comparison of Patient Safety Culture Among Health-Care Providers in Shenzhen Hospitals. Risk Manag Healthc Policy 2020; 13:1543-1552. [PMID: 32982512 PMCID: PMC7494381 DOI: 10.2147/rmhp.s266813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the health-care providers’ perceptions of patient safety culture in Shenzhen hospitals and to compare 2019 with 2015 data. Methods This cross-sectional study adopted a questionnaire survey and targeted hospital staff fitting the sampling criteria (physicians, nurses, technicians, and managers). A total of 5490 staff from 13 Shenzhen hospitals were surveyed using the Hospital Survey on Patient Safety Culture (HSOPSC). Results The average positive response rates of this study were generally higher than the data from the 2018 Agency for Healthcare Research and Quality (AHRQ) survey and the 2015 HSOPSC Shenzhen survey. Bivariate and multivariate regression showed that respondents who had direct contact with patients were less likely to report high overall patient safety grade. The probability of high overall patient safety grade was rated higher by men than by women. Compared with nurses, the probability of high overall patient safety grade was higher for both physicians and technicians. Conclusion The overall results of the patient safety culture in Shenzhen hospitals were relatively good and have improved significantly in recent years, but some areas of weakness still need improvement. Our recommendations are to develop training programs for various positions, recruit more employees, provide management support, and establish a just culture to promote a strong patient safety culture. Regular assessment is also needed to provide valuable information to hospital leaders on areas requiring improvement and to evaluate the quality improvement plan that has been implemented.
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Affiliation(s)
- Horng-Shuh Hao
- Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, People's Republic of China
| | - Han Gao
- Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, People's Republic of China
| | - Ting Li
- Administrative Office, The Third People's Hospital of Shenzhen, Shenzhen, People's Republic of China
| | - Dan Zhang
- Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, People's Republic of China
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2120
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Woolley A, Li L, Solomon J, Li J, Huang K, Chahal P, Chahal P, Tu G, Chahal P, Chattopadhyay K. What are the development priorities for management of type 2 diabetes by general practitioners in Ningbo, China: a qualitative study of patients' and practitioners' perspectives. BMJ Open 2020; 10:e037215. [PMID: 32912986 PMCID: PMC7485253 DOI: 10.1136/bmjopen-2020-037215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To explore patients' and general practitioners' (GPs') perspectives on primary care management of patients with type 2 diabetes mellitus (T2DM) in Ningbo, China. We aimed to understand the current benefits and challenges and to identify development priorities. DESIGN Exploratory qualitative descriptive study using face-to-face interviews and analysed by thematic, inductive analysis. SETTING 11 primary care facilities spread across the city of Ningbo, China. PARTICIPANTS 23 patients with T2DM and 20 GPs involved in caring for patients with T2DM. RESULTS GPs were considered the first point of contact and providers of information. However, the care varied, and many GPs lacked confidence and felt overworked. The medication was a particularly weak area. The diagnostic screening commenced late, leading to crisis presentations. Patients were variably informed about their condition, contributing to poor adherence. CONCLUSIONS Future developments of primary care for T2DM in Ningbo should centre around improving GP confidence and workload and patient education and adherence.
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Affiliation(s)
- Angharad Woolley
- Department of Research and Knowledge Exchange, University of Nottingham, Ningbo, China
- Department of Research and Innovation, University of Nottingham, Nottingham, United Kingdom
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Josie Solomon
- School of Pharmacy, University of Lincoln, Brayford Campus, Lincoln, United Kingdom
| | - Jialin Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Kai Huang
- Department of General Practice, Ningbo First Hospital, Ningbo, China
| | - Punam Chahal
- Department of Research and Knowledge Exchange, University of Nottingham, Ningbo, China
- Department of Research and Innovation, University of Nottingham, Nottingham, United Kingdom
| | - Priya Chahal
- Department of Research and Knowledge Exchange, University of Nottingham, Ningbo, China
- Department of Research and Innovation, University of Nottingham, Nottingham, United Kingdom
| | - Gloria Tu
- Department of Research and Knowledge Exchange, University of Nottingham, Ningbo, China
- Department of Research and Innovation, University of Nottingham, Nottingham, United Kingdom
| | - Pritpal Chahal
- Health Education England, Leeds, United Kingdom
- Division of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
- The Nottingham Centre for Evidence-Based Healthcare: a Joanna Briggs Institute Centre of Excellence, University of Nottingham, Nottingham, United Kingdom
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2121
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Means AR, Wagner AD, Kern E, Newman LP, Weiner BJ. Implementation Science to Respond to the COVID-19 Pandemic. Front Public Health 2020; 8:462. [PMID: 32984248 PMCID: PMC7493639 DOI: 10.3389/fpubh.2020.00462] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/23/2020] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic continues to expand globally, requiring massive public health responses from national and local governments. These bodies have taken heterogeneous approaches to their responses, including when and how to introduce and enforce evidence-based interventions-such as social distancing, hand-washing, personal protective equipment (PPE), and testing. In this commentary, we reflect on opportunities for implementation science to contribute meaningfully to the COVID-19 pandemic response. We reflect backwards on missed opportunities in emergency preparedness planning, using the example of PPE stockpiling and supply management; this planning could have been strengthened through process mapping with consensus-building, microplanning with simulation, and stakeholder engagement. We propose current opportunities for action, focusing on enhancing the adoption, fidelity, and sustainment of hand washing and social distancing; we can combine qualitative data, policy analysis, and dissemination science to inform agile and rapid adjustment to social marketing strategies to enhance their penetration. We look to future opportunities to enhance the integration of new evidence in decision-making, focusing on serologic and virologic testing systems; we can leverage simulation and other systems engineering modeling to identify ideal system structures. Finally, we discuss the ways in which the COVID-19 pandemic challenges implementation science to become more rapid, rigorous, and nimble in its approach, and integrate with public health practice. In summary, we articulate the ways in which implementation science can inform, and be informed by, the COVID-19 pandemic, looking backwards, proposing actions for the moment, and approaches for the future.
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Affiliation(s)
- Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Eli Kern
- Public Health—Seattle and King County, Seattle, WA, United States
| | - Laura P. Newman
- Department of Global Health, University of Washington, Seattle, WA, United States
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Seattle, WA, United States
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Health Services, University of Washington, Seattle, WA, United States
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2122
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Molan A, Nosaka K, Hunter M, Wang W. Seroprevalence and associated risk factors of Toxoplasma gondii infection in a representative Australian human population: The Busselton health study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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2123
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Lee CW, Chen GL, Lee YK. User Experience Evaluation of the EPAs-Based e-Portfolio System and an Analysis of Its Impact. J Acute Med 2020; 10:115-125. [PMID: 33209570 DOI: 10.6705/j.jacme.202009_10(3).0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background To carry out competency-based medical education, this study has established five Entrustable Professional Activities (EPAs) for the emergency medicine residents. The EPAs involve substantial data collection, which requires integration and analysis for the fi nal interpretation. Therefore, the "EPAs-Based e-Portfolio System" has been developed for assisting users to perform ad-hoc assessment, recording of a discussion, teaching, and feedback. The purpose of this study is to examine, from the perspective of the Technology Acceptance Model, residents and clinicians' experience of the EPAs-Based e-Portfolio System, including the use of functions such as recording, feedback, and assessment, as well as the impact thereof. Methods This study uses in-depth interviews as a means of data collection. The interviewees are from emergency medicine training hospitals in north, central, and south Taiwan-11 resident doctors and nine medical teachers. Results The interviewees agree that (1) the EPAs-based e-Portfolio System provides users with a complete learning trajectory record through cloudization and ease of use; (2) it can assist users to gain feedback, case review, and reflection; (3) information on user status can reflect their learning progress, competencies, and performance; (4) other potential functions that can be added include shortcut keys, initiation of assessment sheets by a learner, feedback to teacher's comment, and voice/picture input. Conclusions The results of this study indicate that the easier a system is for users to use, the more helpful they will consider it and the more positive they will be, which will then translate into greater willingness to use the system and higher frequency of actual use. The system can authentically reflect trainees' professional capabilities if the ad-hoc teaching and feedback in the clinical setting connect strongly with the online assessment and recording.
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Affiliation(s)
- Chen-Wei Lee
- Buddhist Tzu Chi Medical Foundation Department of Emergency Medicine, Dalin Tzu Chi Hospital Chiayi Taiwan
| | - Guan-Liang Chen
- National Chung Cheng University Center for Innovative Research on Aging Society Chiayi Taiwan
| | - Yi-Kung Lee
- Buddhist Tzu Chi Medical Foundation Department of Emergency Medicine, Dalin Tzu Chi Hospital Chiayi Taiwan.,Tzu Chi University School of Medicine Hualien Taiwan
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2124
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Ozcelik S, Alim M, Ozpinar N. Detection of Toxoplasma gondii infection among diabetic patients in Turkey. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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2125
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Reddy BV, Gupta A. Importance of effective communication during COVID-19 infodemic. J Family Med Prim Care 2020; 9:3793-3796. [PMID: 33110769 PMCID: PMC7586512 DOI: 10.4103/jfmpc.jfmpc_719_20] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/11/2020] [Accepted: 06/23/2020] [Indexed: 11/04/2022] Open
Abstract
The impact of COVID-19 on vulnerable groups would rely in part on the quality of communication regarding health risk and danger. Strategic planning should take full account of the way life conditions, cultural values, and risk experience affect actions during a pandemic. Concept of information education communication, Social behaviour change communication, social marketing usually technology and media is recapitulation. Ignorance with sociocultural, economic, psychological, and health factors can jeopardize effective communication at all levels. We summarized the framework for effective communication during pandemic. Understanding and practicing various communication strategies is crucial for physicians and health care workers to develop therapeutic relationships with COVID-19 patients. Addressing psychology in all people is vital during a pandemic and effective communication network is key to it. Effective communication, if ignored, will generate gaps for vulnerable populations and result in added difficulty in combating COVID-19 pandemic.
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Affiliation(s)
- B Venkatashiva Reddy
- Department of Community Medicine, NRI Academy of Medical Sciences, Guntur, Andhra Pradesh, India
| | - Arti Gupta
- Department of Community and Family Medicine, All India Institute of Medical Sciences Mangalagiri, Andhra Pradesh, India
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2126
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Primary care doctors' views on self-monitoring of blood pressure and self-titration among patients with uncontrolled hypertension in Spain. The ADAMPA trial focus group study. BJGP Open 2020; 4:bjgpopen20X101062. [PMID: 32816741 PMCID: PMC7606147 DOI: 10.3399/bjgpopen20x101062] [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: 12/09/2019] [Accepted: 01/20/2020] [Indexed: 11/11/2022] Open
Abstract
Background Despite the increased use of blood pressure (BP) monitoring devices at home, the hypertension of more than 50% of European patients remains uncontrolled. Nevertheless, the self-management of BP, through the combination of home monitoring of BP with self-titration, could be anaccessible and effective tool for improving hypertension control in the primary care setting. The ADAMPA study is a trial with participants randomised to BP self-management (BPSM) with self-titration of antihypertensive medication or to usual care, in a population of patients with poorly controlled hypertension. Aim To explore the views and attitudes of primary care doctors participating in the ADAMPA trial regarding BPSM with self-titration. Design & setting A focus group study took place with primary care doctors participating in the ADAMPA trial, which was carried out in one health district of the Valencia Health System in Spain. Method Nine primary care doctors participating in the ADAMPA trial were included in the focus group. Three researchers (two using manual methods and one using NVivo software) independently conducted a content analysis, reading the transcripts, identifying, classifying, and coding the contents, and developing a conceptual scheme based on these topics. Results Participating doctors clearly support home BP monitoring (HBPM), the setting of individual BP targets, and incorporating patient readings into decision-making. They consider it an investment to educate patients for medication self-adjustment and estimate that an important proportion of their patients are potential candidates for hypertension self-management with medication self-titration. However, they show important divergences regarding the role of nursing in BP control. Conclusion Primary care doctors participating in the ADAMPA trial feel comfortable with BPSM with self-titration, and would consider extending its use (or the use of some components, such as BP target setting) to other patients with hypertension outside the trial.
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2127
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Ali SH, Misra S, Parekh N, Murphy B, DiClemente RJ. Preventing type 2 diabetes among South Asian Americans through community-based lifestyle interventions: A systematic review. Prev Med Rep 2020; 20:101182. [PMID: 32844084 PMCID: PMC7441043 DOI: 10.1016/j.pmedr.2020.101182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
Ethnic South Asian Americans (SAAs) have the highest relative risk of type 2 diabetes mellitus (T2DM) in the United States (US). Culturally tailored lifestyle interventions have the potential to promote South Asian diabetes prevention; however, the extent of their use and evaluation in US settings remains limited. This systematic review characterizes and evaluates outcomes of community-based lifestyle interventions targeted towards T2DM indicators among South Asians living in the US. A PRISMA-informed search of Pubmed, Embase, Cochrane, Web of Science, and clinical trial registry databases using key words pertaining to South Asians migrants and diabetes indicators (glucose and insulin outcomes) was conducted of community-based lifestyle interventions published up until October, 31 2019. Of the eight studies included in the final synthesis, four interventions focused on cultural and linguistic adaptations of past chronic disease prevention curricula using group-based modalities to deliver the intervention. Hemoglobin A1c (A1c) was the most common outcome indicator measured across the interventions. Three of the five studies observed improvements in indicators post-intervention. Based on these findings, this review recommends 1) greater exploration of community-based lifestyle interventions with high quality diabetes indicators (such as fasting blood glucose) in ethnic SAA communities, 2) expanding beyond traditional modalities of group-based lifestyle interventions and exploring the use of technology and interventions integrated with passive, active, and individualized components, and 3) development of research on diabetes prevention among second generation SAAs.
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Affiliation(s)
- Shahmir H. Ali
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Supriya Misra
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Niyati Parekh
- Public Health Nutrition Program, School of Global Public Health, New York University, New York, NY, United States
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Bridget Murphy
- Public Health Nutrition Program, School of Global Public Health, New York University, New York, NY, United States
| | - Ralph J. DiClemente
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
- Corresponding author at: 715 Broadway New York, NY 10003, United States.
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2128
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Wu H, Liu Y. Examining inequality in utilisation of health management services for the elderly in rural Henan China. BMC Health Serv Res 2020; 20:758. [PMID: 32807153 PMCID: PMC7433128 DOI: 10.1186/s12913-020-05630-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background The health management plays an important role in improving the quality of life of the elderly and relieving the pressure of health resource consumption. This study aims to assess the income-related inequality in utilisation of health management services (HMS) for the elderly and the contribution of the related factors to inequality in rural Henan China. Methods The data from 2015 Henan Rural Residents Health Survey with 1403 elderly people as the final sample were used for analysis. The concentration index (CI) was used to measure inequality in HMS utilisation for the elderly (no HMS, health assessment, physical examination, auxiliary examination, and health guidance). The decomposition of CI was adopted to explain the contribution of various determinants to inequality in HMS utilisation for the elderly. Results No HMS utilisation was disproportionately concentrated among the poor (CI = − 0.0730, p = 0.0155), utilisation of physical and auxiliary examination was disproportionately concentrated among the rich (CI = 0.0575, p = 0.0448; CI = 0.0811, p = 0.0044). In addition, the pro-poor effects of health assessment and guidance utilisation were not statistically significant (CI = − 0.0173, p = 0.4617; CI = − 0.0213, p = 0.3900). The results of CI decomposition revealed that household income and family size made positive contributions to inequality while social medical insurance, gender, marital status, and age made negative contributions to inequality. The improved service satisfaction with village clinics could reduce inequality in HMS utilisation, while the improved service satisfaction with township hospitals could increase inequality in HMS utilisation. Conclusions Although HMS for the elderly is provided free of charge, its accessibility remains pro-rich due to various factors. Policy makers should adopt effective interventions to resolve the contradiction between these factors and the utilisation of HMS, and redress inequality in the utilisation of HMS.
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Affiliation(s)
- Huan Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Management Institute, Xinxiang Medical University, Xinxiang, Henan, China
| | - Yaqing Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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2129
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Ladhani SN, Amin-Chowdhury Z, Davies HG, Aiano F, Hayden I, Lacy J, Sinnathamby M, de Lusignan S, Demirjian A, Whittaker H, Andrews N, Zambon M, Hopkins S, Ramsay ME. COVID-19 in children: analysis of the first pandemic peak in England. Arch Dis Child 2020. [PMID: 32796006 DOI: 10.1136/archdischild‐2020‐320042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess disease trends, testing practices, community surveillance, case-fatality and excess deaths in children as compared with adults during the first pandemic peak in England. SETTING England. PARTICIPANTS Children with COVID-19 between January and May 2020. MAIN OUTCOME MEASURES Trends in confirmed COVID-19 cases, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity rates in children compared with adults; community prevalence of SARS-CoV-2 in children with acute respiratory infection (ARI) compared with adults, case-fatality rate in children with confirmed COVID-19 and excess childhood deaths compared with the previous 5 years. RESULTS Children represented 1.1% (1,408/129,704) of SARS-CoV-2 positive cases between 16 January 2020 and 3 May 2020. In total, 540 305 people were tested for SARS-COV-2 and 129,704 (24.0%) were positive. In children aged <16 years, 35,200 tests were performed and 1408 (4.0%) were positive for SARS-CoV-2, compared to 19.1%-34.9% adults. Childhood cases increased from mid-March and peaked on 11 April before declining. Among 2,961 individuals presenting with ARI in primary care, 351 were children and 10 (2.8%) were positive compared with 9.3%-45.5% in adults. Eight children died and four (case-fatality rate, 0.3%; 95% CI 0.07% to 0.7%) were due to COVID-19. We found no evidence of excess mortality in children. CONCLUSIONS Children accounted for a very small proportion of confirmed cases despite the large numbers of children tested. SARS-CoV-2 positivity was low even in children with ARI. Our findings provide further evidence against the role of children in infection and transmission of SARS-CoV-2.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, London, UK
- Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
| | | | - Hannah G Davies
- Immunisation and Countermeasures Division, Public Health England, London, UK
- Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
| | - Felicity Aiano
- Immunisation and Countermeasures Division, Public Health England, London, UK
| | - Iain Hayden
- Immunisation and Countermeasures Division, Public Health England, London, UK
| | - Joanne Lacy
- Immunisation and Countermeasures Division, Public Health England, London, UK
| | - Mary Sinnathamby
- Immunisation and Countermeasures Division, Public Health England, London, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Antimicrobial Resistance and Hospital-acquired Infections Department, Public Health England, London, UK
| | - Alicia Demirjian
- Antimicrobial Resistance and Hospital-acquired Infections Department, Public Health England, London, UK
- Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Heather Whittaker
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - Maria Zambon
- Microbiological Services Colindale, Public Health England, London, UK
| | - Susan Hopkins
- Antimicrobial Resistance and Hospital-acquired Infections Department, Public Health England, London, UK
| | - Mary Elizabeth Ramsay
- Immunisation and Countermeasures Division, Public Health England, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
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Hayashi M, Son D, Nanishi K, Eto M. Long-term contribution of international electives for medical students to professional identity formation: a qualitative study. BMJ Open 2020; 10:e039944. [PMID: 32801209 PMCID: PMC7430439 DOI: 10.1136/bmjopen-2020-039944] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Globalisation has given medical university students the opportunity to pursue international electives in other countries, enhancing the long-term socialisation of medical professionals. This study identified the long-term effects of international electives on the professional identity formation of medical students. DESIGN This is a qualitative study. SETTING The authors interviewed Japanese medical professionals who had completed their international electives more than 10 years ago, and analysed and interpreted the data using a social constructivism paradigm. PARTICIPANTS A total of 23 medical professionals (mean age 36.4 years; range 33-42 years) participated in face-to-face, semistructured in-depth interviews. RESULTS During the data analysis, 36 themes related to professional identity formation were identified, and the resulting themes had five primary factors (perspective transformation, career design, self-development, diversity of values and leadership). It was concluded that international electives for medical students could promote reflective self-relativisation and contribute to medical professional identity formation. Additionally, such electives can encourage pursuing a specialisation and academic or non-academic work abroad. International electives for medical students could contribute to medical professional identity formation on the basis of cross-cultural understanding. CONCLUSIONS This study addressed a number of issues regarding the long-term impact of international elective experiences in various countries on the professional identity formation of Japanese medical professionals. This study offers some guidance to mentors conducting international electives and provides useful information for professional identity formation development in medical professionals.
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Affiliation(s)
- Mikio Hayashi
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Daisuke Son
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Community-based Family Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Keiko Nanishi
- Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Armin JS, Nair U, Giacobbi P, Povis G, Barraza Y, Gordon JS. Developing a Guided Imagery Telephone-Based Tobacco Cessation Program for a Randomized Controlled Trial. Tob Use Insights 2020; 13:1179173X20949267. [PMID: 32922107 PMCID: PMC7446272 DOI: 10.1177/1179173x20949267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS Guided imagery is an evidence-based, multi-sensory, cognitive process that can be used to increase motivation and achieve a desired behavior. Quitlines are effective, standard care approaches for tobacco cessation; however, utilization of quitlines is low. Using guided imagery-based interventions for smoking cessation may appeal to smokers who do not utilize traditional quitline services. This paper reports the development of program materials for a randomized controlled feasibility trial of a guided imagery-based smoking cessation intervention. The objective of the formative work was to ensure that program materials are inclusive of groups that are less likely to use quitlines, including men and racial/ethnic minority tobacco users. METHODS A three-phase process was used to complete formative assessment: (1) integration of evidence-based cessation practices into program development; (2) iterative small group interviews (N = 46) to modify the program; and (3) pilot-testing the coaching protocol and study process among a small sample of smokers (N = 5). RESULTS The Community Advisory Board and project consultants offered input on program content and study recruitment based on their knowledge of minority communities with whom they conduct outreach. Small group interview participants included members of underserved quitline populations (52.37% non-white; 55.56% men). Only 28.26% of participants had prior experience with guided imagery, but others described the use of similar mindfulness and meditation practices. Participant feedback was incorporated into program materials and protocols. DISCUSSION Iteratively collected feedback and pilot testing influenced program content and delivery and informed study processes for a randomized controlled feasibility trial of a telephone-delivered, guided imagery-based intervention.
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Affiliation(s)
- Julie S Armin
- Department of Family & Community Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Uma Nair
- Department of Family & Community Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Peter Giacobbi
- College of Physical Activity and Sport Sciences and School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Gayle Povis
- The University of Arizona Collaboratory for Metabolic Disease Prevention and Treatment, Tucson AZ, USA
| | - Yessenya Barraza
- The University of Arizona Collaboratory for Metabolic Disease Prevention and Treatment, Tucson AZ, USA
| | - Judith S Gordon
- College of Nursing, The University of Arizona, Tucson, AZ, USA
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Contini C, Caselli E, Martini F, Maritati M, Torreggiani E, Seraceni S, Vesce F, Perri P, Rizzo L, Tognon M. COVID-19 Is a Multifaceted Challenging Pandemic Which Needs Urgent Public Health Interventions. Microorganisms 2020; 8:E1228. [PMID: 32806657 PMCID: PMC7464234 DOI: 10.3390/microorganisms8081228] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/27/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023] Open
Abstract
Until less than two decades ago, all known human coronaviruses (CoV) caused diseases so mild that they did not stimulate further advanced CoV research. In 2002 and following years, the scenario changed dramatically with the advent of the new more pathogenic CoVs, including Severe Acute Respiratory Syndome (SARS-CoV-1), Middle Eastern respiratory syndrome (MERS)-CoV, and the new zoonotic SARS-CoV-2, likely originated from bat species and responsible for the present coronavirus disease (COVID-19), which to date has caused 15,581,007 confirmed cases and 635,173 deaths in 208 countries, including Italy. SARS-CoV-2 transmission is mainly airborne via droplets generated by symptomatic patients, and possibly asymptomatic individuals during incubation of the disease, although for the latter, there are no certain data yet. However, research on asymptomatic viral infection is currently ongoing worldwide to elucidate the real prevalence and mortality of the disease. From a clinical point of view, COVID-19 would be defined as "COVID Planet " because it presents as a multifaceted disease, due to the large number of organs and tissues infected by the virus. Overall, based on the available published data, 80.9% of patients infected by SARS-CoV-2 develop a mild disease/infection, 13.8% severe pneumonia, 4.7% respiratory failure, septic shock, or multi-organ failure, and 3% of these cases are fatal, but mortality parameter is highly variable in different countries. Clinically, SARS-CoV-2 causes severe primary interstitial viral pneumonia and a "cytokine storm syndrome", characterized by a severe and fatal uncontrolled systemic inflammatory response triggered by the activation of interleukin 6 (IL-6) with development of endothelitis and generalized thrombosis that can lead to organ failure and death. Risk factors include advanced age and comorbidities including hypertension, diabetes, and cardiovascular disease. Virus entry occurs via binding the angiotensin-converting enzyme 2 (ACE2) receptor present in almost all tissues and organs through the Spike (S) protein. Currently, SARS-CoV-2 infection is prevented by the use of masks, social distancing, and improved hand hygiene measures. This review summarizes the current knowledge on the main biological and clinical features of the SARS-CoV-2 pandemic, also focusing on the principal measures taken in some Italian regions to face the emergency and on the most important treatments used to manage the COVID-19 pandemic.
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Affiliation(s)
- Carlo Contini
- Infectious Diseases and Dermatology Section, Pathology, Oncology and Experimental Biology Section, Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy; (F.M.); (E.T.); (M.T.)
| | - Elisabetta Caselli
- Department of Chemical and Pharmaceutical Sciences, Microbiology Section, University of Ferrara, 44124 Ferrara, Italy;
| | - Fernanda Martini
- Infectious Diseases and Dermatology Section, Pathology, Oncology and Experimental Biology Section, Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy; (F.M.); (E.T.); (M.T.)
| | - Martina Maritati
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44124 Ferrara, Italy;
| | - Elena Torreggiani
- Infectious Diseases and Dermatology Section, Pathology, Oncology and Experimental Biology Section, Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy; (F.M.); (E.T.); (M.T.)
| | - Silva Seraceni
- RDI, Rete Diagnostica Italiana s.r.l, Lifebrain Group, Limena, 35010 Padova, Italy;
| | - Fortunato Vesce
- Department of Morphology, Surgery and Experimental Medicine, Obstetrics and Gynecology Section, University of Ferrara, 44124 Ferrara, Italy;
| | - Paolo Perri
- Department of Biomedical Sciences and Surgical Specialties; Ophthalmology Section, University of Ferrara, 44124 Ferrara, Italy;
| | - Leonzio Rizzo
- Department of Economy and Management; University of Ferrara, 44124 Ferrara, Italy;
| | - Mauro Tognon
- Infectious Diseases and Dermatology Section, Pathology, Oncology and Experimental Biology Section, Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy; (F.M.); (E.T.); (M.T.)
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Abstract
Over the course of the new coronavirus infectious disease (coronavirus disease 2019; COVID-19) pandemic, our social situation has been changing dramatically, in addition to the substantial efforts made for the early and appropriate management of COVID-19 and preventing this infection spreading. Recently, neurological symptoms associated with COVID-19 have been shown to be not uncommon, with headaches receiving attention as one of the main neurological symptoms. The frequency of headaches associated with COVID-19 ranged from 5.6% to 70.3%, based on 21 clinical studies and 8 meta-analyses. However, headaches were observed in 11.1% to 81.0% of non-COVID-19 individuals, including healthcare workers caring for COVID-19 patients. Although detailed descriptions of headaches were rarely provided in the literature obtained, in this article, I wil discuss the frequency and characteristics of headaches, and the pathophysiology of headaches as it relateds to COVID-19.
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Thomas T, Ahmed Y, Tan M, Grigorenko EL. Cognitive and Educational Interventions for Orphans and Vulnerable Children Affected by HIV/AIDS: A Meta-Analysis. Child Dev 2020; 92:7-20. [PMID: 32767770 DOI: 10.1111/cdev.13438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Orphans and vulnerable children affected by HIV/AIDS (HIV OVC) are at risk for cognitive difficulties and lack of access to education. Interventions addressing cognitive or educational outcomes for HIV OVC worldwide were examined through systematic searches conducted from October 2016 to 2019. We examined the summative effectiveness of interventions and the specific effects of participant age and intervention length. Interventions targeting cognitive outcomes had a small, significant effect, with no effect of moderating variables. Interventions targeting educational outcomes had significant effects. Educational interventions over 1 year were effective, but effects of intervention length were not significant. Overall, this review provides support for the effectiveness of interventions targeting cognitive and educational outcomes for OVC and highlights the need for more research on such interventions.
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2135
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Network Engagement in Action: Stakeholder Engagement Activities to Enhance Patient-centeredness of Research. Med Care 2020; 58 Suppl 6 Suppl 1:S66-S74. [PMID: 32412955 DOI: 10.1097/mlr.0000000000001264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stakeholders (ie, patients, policymakers, clinicians, advocacy groups, health system leaders, payers, and others) offer critical input at various stages in the research continuum, and their contributions are increasingly recognized as an important component of effective translational research. Natural experiments, in particular, may benefit from stakeholder feedback in addressing real-world issues and providing insight into future policy decisions, though best practices for the engagement of stakeholders in observational studies are limited in the literature. METHODS The Natural Experiments for Translation in Diabetes 2.0 (NEXT-D2) network utilizes rigorous methods to evaluate natural experiments in health policy and program delivery with a focus on diabetes-related outcomes. Each of the 8 partnering institutions incorporates stakeholder engagement throughout multiple study phases to enhance the patient-centeredness of results. NEXT-D2 dedicates a committee to Engagement for resource sharing, enhancing engagement approaches, and advancing network-wide engagement activities. Key stakeholder engagement activities include Study Meetings, Proposal Development, Trainings & Educational Opportunities, Data Analysis, and Results Dissemination. Network-wide patient-centered resources and multimedia have also been developed through the broad expertise of each site's stakeholder group. CONCLUSIONS This collaboration has created a continuous feedback loop wherein site-level engagement approaches are informed via the network and network-level engagement efforts are shaped by individual sites. Emerging best practices include: incorporating stakeholders in multiple ways throughout the research, building on previous relationships with stakeholders, enhancing capacity through stakeholder and investigator training, involving stakeholders in refining outcome choices and understanding the meaning of variables, and recognizing the power of stakeholders in maximizing dissemination.
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Cheng YS, Tan AC, Hsu YC, Chen TJ. To Work at Clinics or at Hospitals? Analysis of Family Physician Recruitment Advertising in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5636. [PMID: 32764259 PMCID: PMC7459441 DOI: 10.3390/ijerph17165636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/17/2022]
Abstract
Family physicians act as gatekeepers of the healthcare system and have an indispensable role in providing holistic care in the primary care system. While previous studies had focused on the geographic maldistribution of family physicians, the current study investigated the distribution of job opportunities for family physicians by analyzing recruitment advertisements posted in medical association journals, as an indirect way to observe the marketplace demand for physicians. We collected all the recruitment advertisements for family physicians in the twelve issues of the Taiwan Medical Journal, the official organ of the Taiwan Medical Association, in 2018. In contrast to 124 new trainees annually, 739 advertisements for family physicians were posted within the entire year. After eliminating repeated advertisements, there were 302 distinct advertisements, of which hospitals accounted for 18.9% (n = 57). The job opportunities at hospitals were offered mainly by regional hospitals (n = 26) and community hospitals (n = 29), but only two by medical centers. Family physicians in Taiwan were in great demand not only by primary care clinics but also by hospitals. The role of family physicians in hospitals is worth further study.
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Affiliation(s)
- Yi-Shin Cheng
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-S.C.); (Y.-C.H.)
| | - Ann Charis Tan
- Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan;
| | - Ya-Chuan Hsu
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-S.C.); (Y.-C.H.)
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-S.C.); (Y.-C.H.)
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan
- Big Data Center, Department of Medical Research, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan
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Sharma SC, Sharma S, Thakker A, Sharma G, Roshan M, Varakantam V. Revolution in UK General Practice Due to COVID-19 Pandemic: A Cross-Sectional Survey. Cureus 2020; 12:e9573. [PMID: 32913690 PMCID: PMC7474564 DOI: 10.7759/cureus.9573] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives To assess how UK General Practitioners (GPs) and Practice Managers (PMs) have coped with the challenges posed by the coronavirus disease-19 (COVID-19) pandemic and whether they felt adequately supported by the wider National Health Service (NHS). Methods This is a cross-sectional survey. All GPs and PMs (total 1,354) in Leicester, Leicestershire, and Rutland (LLR) were invited to participate in an online questionnaire. Results A total of 95 invitees completed the survey. Over a quarter had required time off work due to COVID symptoms or contact. All respondents described either introducing or increasing the use of remote patient consultations. Most striking was the rise in video consultations from just 3% to 95% during the pandemic. Almost half of the feedback on the usefulness of remote consultations were positive, 16% were negative and 17% were mixed. The most commonly cited benefit was time efficiency. Drawbacks of remote consultations included technical difficulties and poor patient communication. Practice premises, systems and processes also required significant modifications during the pandemic to ensure the provision of safe clinical care, including reception screens, one-way patient flow, greater infection prevention measures. However, despite their ability to introduce such widescale change virtually overnight, over 10% of respondents reported that the strain had placed their practice at risk of closure. Over half of respondents felt they were not provided with adequate personal protective equipment (PPE) for the safety of their staff. Perception of the support provided by NHS England and the Clinical Commissioning Groups (CCGs) was rather mixed, although additional guidelines were broadly welcomed. The most requested enduring changes related to remote patient consultations (59%) and remote triage (19%). However, in order to support such largescale permanent change, study respondents felt that a different funding and financial structure is required together with improved IT infrastructure, greater patient education and a more supportive regulatory environment. Conclusions COVID-19 has substantially accelerated the pace of change within NHS primary care. The long-term fear is that there may be insufficient financial and clinical backing from regulatory bodies to support such rapid and far-reaching changes.
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Affiliation(s)
| | - Sonita Sharma
- Family Medicine, University of Buckingham Medical School, Buckingham, GBR
| | - Arjuna Thakker
- Family Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Gopal Sharma
- Family Medicine, Fosse Medical Centre, Leicester, GBR
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Esakandari H, Nabi-Afjadi M, Fakkari-Afjadi J, Farahmandian N, Miresmaeili SM, Bahreini E. A comprehensive review of COVID-19 characteristics. Biol Proced Online 2020; 22:19. [PMID: 32774178 PMCID: PMC7402395 DOI: 10.1186/s12575-020-00128-2] [Citation(s) in RCA: 245] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022] Open
Abstract
In December 2019, a novel coronavirus, named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or (2019-nCoV) with unknown origin spread in Hubei province of China. The epidemic disease caused by SARS-CoV-2 called coronavirus disease-19 (COVID-19). The presence of COVID-19 was manifested by several symptoms, ranging from asymptomatic/mild symptoms to severe illness and death. The viral infection expanded internationally and WHO announced a Public Health Emergency of International Concern. To quickly diagnose and control such a highly infectious disease, suspicious individuals were isolated and diagnostic/treatment procedures were developed through patients' epidemiological and clinical data. Early in the COVID-19 outbreak, WHO invited hundreds of researchers from around the world to develop a rapid quality diagnosis, treatment and vaccines, but so far no specific antiviral treatment or vaccine has been approved by the FDA. At present, COVID-19 is managed by available antiviral drugs to improve the symptoms, and in severe cases, supportive care including oxygen and mechanical ventilation is used for infected patients. However, due to the worldwide spread of the virus, COVID-19 has become a serious concern in the medical community. According to the current data of WHO, the number of infected and dead cases has increased to 8,708,008 and 461,715, respectively (Dec 2019 -June 2020). Given the high mortality rate and economic damage to various communities to date, great efforts must be made to produce successful drugs and vaccines against 2019-nCoV infection. For this reason, first of all, the characteristics of the virus, its pathogenicity, and its infectious pathways must be well known. Thus, the main purpose of this review is to provide an overview of this epidemic disease based on the current evidence.
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Affiliation(s)
- Hanie Esakandari
- Department of Biology, Science and research branch, Islamic Azad University of Tehran, Tehran, Iran
| | - Mohsen Nabi-Afjadi
- Department of Biochemistry, Faculty of biological science, Tarbiat Modares University, Tehran, Iran
| | - Javad Fakkari-Afjadi
- Department of biology, Ashkezar branch, Islamic Azad University of Yazd, Ashkezar, Yazd Iran
| | - Navid Farahmandian
- Department of Biochemistry, Faculty of Medicine, Iran University of Medical Sciences, P.O. Box: 1449614525, Tehran, Iran
| | | | - Elham Bahreini
- Department of biology, Ashkezar branch, Islamic Azad University of Yazd, Ashkezar, Yazd Iran
- Department of Biochemistry, Faculty of Medicine, Iran University of Medical Sciences, P.O. Box: 1449614525, Tehran, Iran
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Wandernoth P, Kriegsmann K, Groh-Mohanu C, Daeumer M, Gohl P, Harzer O, Kriegsmann M, Kriegsmann J. Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by Mass Spectrometry. Viruses 2020; 12:v12080849. [PMID: 32759673 PMCID: PMC7472307 DOI: 10.3390/v12080849] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Amplification of viral ribonucleic acid (RNA) by real-time reverse transcriptase polymerase chain reaction (rRT-PCR) is the gold standard to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the initial outbreak, strategies to detect and isolate patients have been important to avoid uncontrolled viral spread. Although testing capacities have been upscaled, there is still a need for reliable high throughput test systems, specifically those that require alternative consumables. Therefore, we tested and compared two different methods for the detection of viral PCR products: rRT-PCR and mass spectrometry (MS). Methods: Viral RNA was isolated and amplified from oro- or nasopharyngeal swabs. A total of 22 samples that tested positive and 22 samples that tested negative for SARS-CoV-2 by rRT-PCR were analyzed by MS. Results of the rRT-PCR and the MS protocol were compared. Results: Results of rRT-PCR and the MS test system were in concordance in all samples. Time-to-results was faster for rRT-PCR. Hands-on-time was comparable in both assays. Conclusions: MS is a fast, reliable and cost-effective alternative for the detection of SARS-CoV-2 from oral and nasopharyngeal swabs.
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Affiliation(s)
- Petra Wandernoth
- Center for Histology, Cytology and Molecular Diagnostics Trier, 54296 Trier, Germany; (P.W.); (C.G.-M.); (J.K.)
| | - Katharina Kriegsmann
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Cristina Groh-Mohanu
- Center for Histology, Cytology and Molecular Diagnostics Trier, 54296 Trier, Germany; (P.W.); (C.G.-M.); (J.K.)
| | - Martin Daeumer
- Kaiserslautern Medical Laboratory, Institute of Immunology and Genetics, 67655 Kaiserslautern, Germany;
| | - Peter Gohl
- Bioscientia, 576080 Ingelheim, Germany; (P.G.); (O.H.)
| | - Oliver Harzer
- Bioscientia, 576080 Ingelheim, Germany; (P.G.); (O.H.)
| | - Mark Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- German Center for Lung Cancer Research (DZL), 69120 Heidelberg, Germany
- Correspondence:
| | - Joerg Kriegsmann
- Center for Histology, Cytology and Molecular Diagnostics Trier, 54296 Trier, Germany; (P.W.); (C.G.-M.); (J.K.)
- Danube Private University Krems, 3500 Krems, Austria
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Chaudhri I, Koraishy FM, Bolotova O, Yoo J, Marcos LA, Taub E, Sahib H, Bloom M, Ahmad S, Skopicki H, Mallipattu SK. Outcomes Associated with the Use of Renin-Angiotensin-Aldosterone System Blockade in Hospitalized Patients with SARS-CoV-2 Infection. KIDNEY360 2020; 1:801-809. [PMID: 33345195 PMCID: PMC7748256 DOI: 10.34067/kid.0003792020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data regarding the benefits or harm associated with the continuation of Angiotensin Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Blockers (ARBs), especially the impact on inflammation, in hypertensive, hospitalized patients with COVID-19 in the United States is unclear. METHODS This is a single-center cohort study of sequentially hospitalized patients with COVID-19 at Stony Brook University Medical Center from March 7, 2020 to April 1, 2020, inclusive of these dates. Data collection included history of known comorbidities, medications, vital signs and laboratory values (admission and during the hospitalization). Outcomes include inflammatory burden (composite scores for multiple markers of inflammation), acute kidney injury (AKI), admission to the intensive care unit (ICU), need for invasive mechanical ventilation, and mortality. RESULTS Of the 300 patients in the study cohort, 80 patients (26.7%) had history of ACEI or ARB use prior to admission, with 61.3% (49/80) of these patients continuing the medications during hospitalization. Multivariable analysis revealed that the history of ACEI or ARB use prior to hospitalization was not associated with worse outcomes. In addition, the continuation of these agents during hospitalization was not associated with an increase in adverse outcomes and predicted fewer ICU admissions (OR=0.25, 0.08-0.81) with a decrease in the severity of inflammatory burden (peak CRP (6.9±3.1mg/dl, p=0.03) and peak inflammation score (2.3±1.1unit reduction, p=0.04)). CONCLUSION Use of ACEI or ARBs prior to hospitalization was not associated with adverse outcomes in COVID-19 and the therapeutic benefits of continuing ACEI or ARB in hospitalized patients with COVID-19 was not offset by adverse outcomes.
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Affiliation(s)
- Imran Chaudhri
- Department of Medicine, Stony Brook University, Stony Brook, New York
| | | | - Olena Bolotova
- Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Jeanwoo Yoo
- Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Luis A. Marcos
- Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Erin Taub
- Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Haseena Sahib
- Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Michelle Bloom
- Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Sahar Ahmad
- Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Hal Skopicki
- Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Sandeep K. Mallipattu
- Department of Medicine, Stony Brook University, Stony Brook, New York
- Renal Section, Northport Veterans Affairs Medical Center, Northport, New York
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2142
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Leem J, Kim KI, Seo JH, Cheong MJ, Youn I. Korean medicine doctors’ views on Western medicine and Korean medicine collaborative treatment in Korea: study protocol for a qualitative study. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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2143
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Degrie L, Dierckx de Casterlé B, Gastmans C, Denier Y. 'Can you please hold my hand too, not only my breast?' The experiences of Muslim women from Turkish and Moroccan descent giving birth in maternity wards in Belgium. PLoS One 2020; 15:e0236008. [PMID: 32726359 PMCID: PMC7390407 DOI: 10.1371/journal.pone.0236008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 06/26/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives To reach nuanced understanding of the perinatal experiences of ethnic minority women from Turkish and Moroccan descent giving birth in maternity wards in Belgium thereby gaining insight into the underlying challenges of providing intercultural care for ethnic minority persons in a hospital setting. Methods A qualitative study design was used by conducting In-depth interviews with 24 women from Turkish and Moroccan descent who gave birth during the past three years in maternity wards in Flanders, Belgium. The interviews were analysed using a Grounded Theory Approach. Results This study shows that the women’s care experiences were shaped by the care interactions with their caregivers, more specifically on the attention that was given by the caregivers towards two essential dimensions of the care relationship, viz. Ereignis (attention to what happens) and Erlebnis (attention to how it happens). These two dimensions were interrelated in four different ways, which defined the women’s care experiences as being either ‘uncaring’, ‘protocolized’, ‘embraced’ or ‘ambiguous’. Moreover, these experiences were fundamentally embedded within the women’s cultural context, which has to be understood as a relational process in which an emotional and moral meaning was given to the women’s care expectations, interactions and interpretations of care. Conclusions The findings reveal that the quality of intercultural care depends on the nature and quality of care interactions between ethnic minority patients and caregivers much more than on the way in which cultural questions and tensions are being handled or dealt with in a practical way. As such, the importance of establishing a meaningful care relationship should be the priority when providing intercultural care. In this, a shift in perspective on ‘culture’ from being an ‘individual culture-in-isolation’ towards an understanding of culture as being inter-relational and emerging from within these care relationships is necessary.
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Affiliation(s)
- Liesbet Degrie
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Bernadette Dierckx de Casterlé
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, University of Leuven, Leuven, Belgium
| | - Chris Gastmans
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Yvonne Denier
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
- * E-mail:
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2144
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Binns E, Kerse N, Peri K, Cheung G, Taylor D. Combining cognitive stimulation therapy and fall prevention exercise (CogEx) in older adults with mild to moderate dementia: a feasibility randomised controlled trial. Pilot Feasibility Stud 2020; 6:108. [PMID: 32724661 PMCID: PMC7382095 DOI: 10.1186/s40814-020-00646-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 07/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background People living with dementia (PLwD) have a high fall risk as cognitive impairment compromises control of gait and balance. Fall prevention exercises that are effective in healthy older adults may not work for PLwD. Cognitive stimulation therapy (CST) has been shown to improve global cognition in PLwD. A programme which combines cognitive (CST) with physical exercises may reduce falls in PLwD. The aim of this study was to assess the feasibility of undertaking a full scale randomised controlled trial to test the effectiveness of CogEx in decreasing falls in PLwD. Specific objectives included recruitment strategy, data collection, outcome measures, intervention fidelity and facilitator/participant experience. Methods A mixed methods feasibility randomised controlled trial recruited people from residential aged care. Inclusion criteria were ≥ 65 years old, Montreal Cognitive Assessment (MoCA) score of 10 to 26 and able to participate in a group. Participants were randomised to CST or CST combined with strength and balance exercises (CogEx). Both CST and CogEx groups were for an hour twice a week for 7 weeks. Descriptive statistics were used to report pre- and post-intervention outcome measures (MoCA, Geriatric Depression Scale–15, Quality of Life-Alzheimer’s Disease, Alzheimer’s Disease Assessment Scale—Cognitive 11, Brief Balance Evaluation Systems Test and Short Form Physical Performance Battery) and attendance. Qualitative analysis of participant focus groups and facilitator interviews used a conventional approach. Sessions were video recorded and exercise completion documented. Results Thirty-six residents were screened with 23 participants randomised to intervention (CogEx, n = 10) or control (CST, n = 13). The assessments took 45 min to 1.5 h, and there was repetition between two cognitive measures. Ten facilitators completed training with the manualised programme. Exercises were combined into the hour-long CST session; however, limited balance training occurred with participants exercising predominantly in sitting. The facilitators felt the participants engaged more and were safer in sitting. Conclusions The results demonstrated that while fall prevention exercises could be scheduled into the CST structure, the fidelity of the combined programme was poor. Other components of the study design need further consideration before evaluation using a randomised controlled trial is feasible. Trial registration anzctr.org.au (ACTRN12616000751471) 8 Jun 2016, Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- Elizabeth Binns
- Physiotherapy Department, AUT University, Auckland, New Zealand.,Health and Rehabilitation Institute, AUT University, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Institute, AUT University, Auckland, New Zealand
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2145
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Krishna A, Pathni AK, Sharma B, Shivashankar R, Shrivastava S, Hering D. A perspective of private health care providers in the state of Madhya Pradesh on adopting key strategies of the India hypertension control initiative. J Clin Hypertens (Greenwich) 2020; 22:1321-1327. [PMID: 33289944 DOI: 10.1111/jch.13944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 12/01/2022]
Abstract
The India Hypertension Control Initiative (IHCI) has been implemented in public health facilities. This study assessed the perspective of private physicians (PPs) on adopting the core strategies of the IHCI in Bhopal district of Madhya Pradesh. A semi-structured interview was purposely applied to 30 PPs to obtain their opinions on standardized hypertension treatment protocols, patient-centered services, and easy-to-use information system in their private practices. Verbatim data were recorded and analyzed thematically. Only 11 PPs followed the state hypertension treatment protocol. Among the remaining 19 PPs, the major reasons for not adopting protocol were (1) limited availability of single component hypertension drugs, (2) preferences for fixed dose combinations (FDCs), and (3) fear of either losing patients due to a lack of immediate blood pressure control or causing drug-related adverse effects. None of the interviewed doctors had resources to provide patient-centered care and use a digital health information system. Overall, the interviewed doctors identified that free supply of hypertension treatment protocol drugs, inclusion of FDCs in treatment protocol, increasing number of staff for follow-up visits, and patient education, IT-based solutions for patient records, employee incentives, and need for national data sharing policies are the key actions to accelerate the adoption of IHCI strategies in the private sector. This exploratory qualitative study suggests that engagement of private sector in the IHCI is feasible. Plans to expand the IHCI to the private sector should consider ensuring the wider availability of hypertension treatment protocol drugs and developing a simple user-friendly digital platform for patient monitoring.
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Affiliation(s)
| | | | | | | | | | - Dagmara Hering
- Lancet Commission on Hypertension Group.,Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
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2146
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Frasca M, Galvin A, Raherison C, Soubeyran P, Burucoa B, Bellera C, Mathoulin-Pelissier S. Palliative versus hospice care in patients with cancer: a systematic review. BMJ Support Palliat Care 2020; 11:188-199. [PMID: 32680891 DOI: 10.1136/bmjspcare-2020-002195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Guidelines recommend an early access to specialised palliative medicine services for patients with cancer, but studies have reported a continued underuse. Palliative care facilities deliver early care, alongside antineoplastic treatments, whereas hospice care structures intervene lately, when cancer-modifying treatments stop. AIM This review identified factors associated with early and late interventions of specialised services, by considering the type of structures studied (palliative vs hospice care). DESIGN We performed a systematic review, prospectively registered on PROSPERO (ID: CRD42018110063). DATA SOURCES We searched Medline and Scopus databases for population-based studies. Two independent reviewers extracted the data and assessed the study quality using Joanna Briggs Institute critical appraisal checklists. RESULTS The 51 included articles performed 67 analyses. Most were based on retrospective cohorts and US populations. The median quality scores were 19/22 for cohorts and 15/16 for cross-sectional studies. Most analyses focused on hospice care (n=37). Older patients, men, people with haematological cancer or treated in small centres had less specialised interventions. Palliative and hospice facilities addressed different populations. Older patients received less palliative care but more hospice care. Patients with high-stage tumours had more palliative care while women and patients with a low comorbidity burden received more hospice care. CONCLUSION Main disparities concerned older patients, men and people with haematological cancer. We highlighted the challenges of early interventions for older patients and of late deliveries for men and highly comorbid patients. Additional data on non-American populations, outpatients and factors related to quality of life and socioeconomic status are needed.
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Affiliation(s)
- Matthieu Frasca
- Department of Palliative Medicine, CHU of Bordeaux, Bordeaux, Aquitaine, France .,Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France
| | - Angeline Galvin
- Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France
| | - Chantal Raherison
- Department of Pneumology, CHU of Bordeaux, Bordeaux, Aquitaine, France
| | - Pierre Soubeyran
- CIC1401, Bergonie institute, Comprehensive Cancer Center, Bordeaux, Aquitaine, France.,UMR 1218, ACTION, University of Bordeaux, Bordeaux, Aquitaine, France
| | - Benoît Burucoa
- Department of Palliative Medicine, CHU of Bordeaux, Bordeaux, Aquitaine, France
| | - Carine Bellera
- Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France.,CIC1401, Bergonie institute, Comprehensive Cancer Center, Bordeaux, Aquitaine, France
| | - Simone Mathoulin-Pelissier
- Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France.,UMR 1218, ACTION, University of Bordeaux, Bordeaux, Aquitaine, France
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2147
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Agénor M, Pérez AE, Tabaac AR, Bond KT, Charlton BM, Bowen DJ, Austin SB. Sexual Orientation Identity Disparities in Mammography Among White, Black, and Latina U.S. Women. LGBT Health 2020; 7:312-320. [PMID: 32668184 PMCID: PMC7475089 DOI: 10.1089/lgbt.2020.0039] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: Our goal was to examine sexual orientation identity disparities in mammography in relationship to race/ethnicity among U.S. women. Methods: Using nationally representative 2013-2017 National Health Interview Survey data, we used multivariable logistic regression to estimate the odds of receiving a mammogram in the past year in relationship to sexual orientation identity among White, Black, and Latina U.S. women 40-75 years of age (N = 45,031) separately, adjusting for demographic factors. We also assessed whether socioeconomic and health care factors attenuated sexual orientation identity disparities in mammography across racial/ethnic groups. Results: Among White women, bisexual women had significantly lower adjusted odds of mammography compared to heterosexual women (odds ratio = 0.70, 95% confidence interval: 0.50-0.99). Among Black women, the adjusted odds of mammography were significantly higher among bisexual women relative to heterosexual women (2.53, 1.08-5.92). Black lesbian women appeared to have lower adjusted odds of mammography compared to their heterosexual counterparts; however, this difference was not statistically significant (0.80, 0.46-1.38). Similarly, among Latina women, lesbian women also seemed to have lower adjusted odds of mammography relative to heterosexual women, but this disparity was also not statistically significant (0.64, 0.37-1.13). Adding socioeconomic factors completely attenuated the disparity between White bisexual and heterosexual women (0.76, 0.52-1.10). Conclusions: Sexual orientation identity disparities in receiving a mammogram in the past year differed in relationship to race/ethnicity among White, Black, and Latina U.S. women. Additional research with larger samples of Black and Latina lesbian and bisexual women is needed to more accurately estimate and explain observed differences.
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Affiliation(s)
- Madina Agénor
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ashley E. Pérez
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Ariella R. Tabaac
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Keosha T. Bond
- Department of Public Health, New York Medical College, Valhalla, New York, USA
| | - Brittany M. Charlton
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Deborah J. Bowen
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | - S. Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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2148
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Topmiller M, Kieber-Emmons AM, Shaak K, McCann JL. Identifying Bright Spot Counties for Appropriate Diabetes Preventive Care: A Geospatial, Positive Deviance Approach. J Prim Prev 2020; 41:431-443. [PMID: 32642939 DOI: 10.1007/s10935-020-00601-4] [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: 10/23/2022]
Abstract
Positive deviance approaches, which have been used to identify and study high performers (bright spots) and translate their successes to poorer performers, offer great potential for chronic disease management. However, there are few examples of applying positive deviance approaches across different geographic contexts. Building on prior research that developed a new measure for appropriate diabetes preventive care (DMPrevCare) and identified priority counties for this strategy, we introduce a geospatial approach for identifying bright spot counties and case matching them to priority counties that need improvement. We used the Local Moran's I tool to identify DMPrevCare spatial outliers, which are counties with larger percentages of Medicare beneficiaries receiving appropriate diabetes preventive care (DMPrevCare) surrounded by counties with smaller percentages of Medicare beneficiaries receiving DMPrevCare. We define these spatial outliers as bright spots. The Robert Wood Johnson Foundation County Health Rankings Peer Counties tool was used to link bright spot counties to previously identified priority counties. We identified 25 bright spot counties throughout the southern and mountain western United States. Bright spot counties were linked to 45 priority counties, resulting in 23 peer (bright/priority) county groups. A geospatial approach was shown to be effective in identifying peer counties across the United States that had either poor or strong metrics related to DMPrevCare, but were otherwise similar in terms of demographics and socioeconomic characteristics. We describe a framework for the next steps in the positive deviance process, which identifies potential factors in bright spot counties that positively impact diabetes care and how they may be applied to their peer priority counties.
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Affiliation(s)
- Michael Topmiller
- HealthLandscape, American Academy of Family Physicians, 3805 Edwards Road, Cincinnati, OH, 45209, USA.
| | - Autumn M Kieber-Emmons
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, USA.,Department of Family Medicine, Morsani School of Medicine, University of South Florida, Tampa, USA
| | - Kyle Shaak
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Jessica L McCann
- HealthLandscape, American Academy of Family Physicians, 3805 Edwards Road, Cincinnati, OH, 45209, USA
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2149
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Leung KM, Chung PK, Chu W. Evaluation of a sitting light volleyball intervention to adults with physical impairments: qualitative study using social-ecological model. BMC Sports Sci Med Rehabil 2020; 12:41. [PMID: 32670590 PMCID: PMC7346623 DOI: 10.1186/s13102-020-00187-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 06/29/2020] [Indexed: 11/15/2022]
Abstract
Background This study was a part of 16-week sitting light volleyball (SLVB) intervention program which examined the effects of the intervention on the physical and psychological attributes of adults with physical impairments (PWPI) in Hong Kong. Gaining a deeper understanding of the perceptions and experiences of PWPI in the SLVB intervention is critical to the development of SLVB as a physical activity and a sport. The aims of this study were (a) to assess participants’ experiences of the intervention and (b) to examine the suitability and feasibility of SLVB intervention for PWPI. Methods Twenty participants (mean age = 53.52 years, standard deviation 9.02 years; 60% female; 25% with at least a college degree) participated in semi-structured interviews. Results Content analysis revealed features of their experiences at the individual or intrapersonal level (physical and psychological health, enjoyment, novelty, competence, autonomy), interpersonal level (socialization and teamwork, social support), organizational and community levels (perceived sport venue environment, venue accessibility, safety, dissemination of information), and policy level (resources allocation by the government). The participants also commented on the suitability and feasibility of the SLVB intervention for PWPI, its content and coaching, the modified rules, the duration of sessions, scheduling, and the number of participants and coaches. Conclusions This study identified several themes relevant to the promotion of PWPI engagement with SLVB and demonstrated that adopting a multilevel approach to the intervention resulted in positive outcomes for participants. Playing SLVB is suitable and feasible for PWPI. The findings contribute to the understanding of the experiences PWPI had of the SLVB intervention, which is critical to the further development of SLVB as a physical activity and a sport.
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Affiliation(s)
- Ka-Man Leung
- Department of Health and Physical Education, Education University of Hong Kong, 10 Lo Ping Rd, Ting Kok, Tai Po, Hong Kong
| | - Pak-Kwong Chung
- Department of Sport and Physical Education, Hong Kong Baptist University, Kowloon Tong, Kowloon, Hong Kong
| | - William Chu
- Department of Sport and Physical Education, Hong Kong Baptist University, Kowloon Tong, Kowloon, Hong Kong
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2150
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Abbey E, Craig C, Mayland CR. General practitioners' perceptions of compassionate communities: a qualitative study. BMC Palliat Care 2020; 19:97. [PMID: 32631288 PMCID: PMC7339557 DOI: 10.1186/s12904-020-00597-y] [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: 02/02/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background General Practitioners (GPs) face challenges when providing palliative care, including an ageing, multimorbid population, and falling GP numbers. A ‘public health palliative care’ approach, defined as “working with communities to improve people’s experience of death, dying and bereavement”, is gaining momentum. ‘Compassionate communities’ is one example, with a focus on linking professional health carers with supportive community networks. Primary care is central to the approach, which has been incorporated into United Kingdom GP palliative care guidance. No research to date, however, has investigated GP perspectives of these approaches. Our aim, therefore, was to explore GP perceptions of a public health approach to palliative care, and compassionate communities. Methods GPs working in the United Kingdom were recruited through university teaching and research networks using snowball sampling. Purposive sampling ensured wide representation of gender, level of experience and practice populations. Semi-structured, digitally audio-recorded interviews were conducted with nine GPs. Interviews were transcribed verbatim, and thematic analysis was undertaken, informed by a qualitative descriptive methodology. Interviews continued until data saturation was reached. Results Most participants were unfamiliar with the term ‘compassionate communities’, but recognised examples within their practice. Three major themes with seven subthemes were identified: 1) Perceived potential of compassionate communities, including: ‘maximising use of existing community services’; ‘influencing health outside of healthcare’; and ‘combatting taboo’, 2) Perceived challenges of compassionate communities, including: ‘patient safety’; ‘limited capacity of the community’; ‘limited capacity of general practice’, and ‘applicability of public health to palliative care’, and 3) The role of the GP in compassionate communities. Conclusions GPs recognised the importance of the wider community in caring for palliative care patients, however most were unfamiliar with the compassionate community approach. Participants held differing views regarding the application of the model, and the position of general practice within this. Further research into the approach’s practical implementation, and exploring the views of other key stakeholders, would help establish the feasibility of compassionate communities in practice, and guide its future application.
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Affiliation(s)
- E Abbey
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK. .,Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK.
| | - C Craig
- Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - C R Mayland
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Palliative Care Institute, University of Liverpool, Liverpool, UK
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