1
|
Alemu FW, Yuan J, Kadish S, Son S, Khan SS, Nulla SM, Nicholson K, Wilk P, Thornton JS, Ali S. Social determinants of unmet need for primary care: a systematic review. Syst Rev 2024; 13:252. [PMID: 39358748 PMCID: PMC11448019 DOI: 10.1186/s13643-024-02647-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 08/22/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Despite primary care being largely free at the point of delivery, many Canadians experience challenges in accessing the services they need. A systematic review was conducted to summarize the evidence on the level of unmet need for primary care in Canada and its social determinants. METHODS MEDLINE, Embase, Cochrane, and Web of Science databases were screened from inception to December 2023 using relevant search terms for primary care and unmet healthcare needs. Quantitative observational studies in the English language that included Canadian adults aged 18 years and older and focused on unmet needs for primary care were included. The risk of bias in the studies was assessed using either the Joanna Briggs Institute (JBI) critical appraisal checklist or the Newcastle-Ottawa Scale. The included studies were synthesized narratively. RESULTS Forty-six studies met the inclusion criteria for this review. Of the included studies, 96% were cross-sectional in design and 91% had low risk of bias. The prevalence of unmet need, mostly self-reported, varied between 6.6% and 25.2% in national studies. Social determinants of unmet needs were heterogeneous across studies. Findings suggest that unmet need for primary care is related to having low income, mental health diagnoses, and chronic conditions, and negatively associated with older age, having better-perceived health, and having a family physician. CONCLUSIONS Universal access to primary care is the founding principle of the Canadian healthcare system. However, we found evidence suggesting that the extent to which primary care needs are met is influenced by social determinants of health. Further research is needed to improve our understanding of the mechanisms of unmet primary care needs in Canada. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021285074.
Collapse
Affiliation(s)
- Feben W Alemu
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ON, Canada
| | - Jane Yuan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ON, Canada
| | - Seth Kadish
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ON, Canada
| | - Surim Son
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ON, Canada
| | - Sunbal Salim Khan
- Department of Medical Sciences, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Safa M Nulla
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ON, Canada
| | - Piotr Wilk
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ON, Canada
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Jane S Thornton
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ON, Canada
- Western Centre for Public Health & Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Shehzad Ali
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ON, Canada.
- Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
- Department of Health Sciences, University of York, Heslington, York, UK.
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Ottawa, ON, Canada.
| |
Collapse
|
2
|
Poza JJ, Gobbo M, Palanca Cámara M, Pérez‐Domper P, Aledo‐Serrano Á. Key steps and barriers in the journey of patients with epilepsy through the National Healthcare System in Spain: The EPIPASS qualitative study. Epilepsia Open 2024; 9:1731-1744. [PMID: 38965814 PMCID: PMC11450596 DOI: 10.1002/epi4.12984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVE Epilepsy requires continuous medical attention from multiple healthcare specialists, specialized facilities, and community-based care. In Spain, there is no standardized approach to epilepsy care. The aim of this study was to identify the factors impacting on the delivery of high-quality care by exploring key steps and barriers along the patient journey through the Spanish National Healthcare System (NHS). METHODS A qualitative study was conducted using opinions and experiences of neurologists, nurses, patients, and caregivers shared in discussion meetings. Using thematic content analyses, relevant aim-focused statements were coded according to prespecified issues in a discussion map (i.e., key steps and barriers), and sub-coded according to emerging issues. Thematic saturation and co-occurrence of key steps/barriers were evaluated to identify the most relevant factors impacting on the delivery of high-quality care. RESULTS Sixty-five stakeholders took part in discussion meetings (36 neurologists, 10 nurses, 10 patients, and nine caregivers). Six key steps on the patient journey were identified: emergency care, diagnosis, drug therapy, follow-up, referral, and interventional treatment. Of these, follow-up was the most relevant step impacting on the delivery of high-quality patient care, followed by drug therapy and diagnosis. Emergency care was considered a hot-spot step with impact throughout the patient journey. Communication (among HCPs and between HCPs and patients) was a barrier to the delivery of high-quality care at several stages of the patient journey, including drug therapy, follow-up, referral, and interventional treatment. Resource availability was a barrier for diagnosis (especially for confirmation), drug therapy (drug availability), and referral (lack of professionals and specialized centers, and long waiting lists). SIGNIFICANCE This is the first study capturing perspectives of four key stakeholders involved in epilepsy care in Spain. We provide an overview of the patient journey through the Spanish NHS and highlight opportunities to improve the delivery of patient-centered care with a chronicity perspective. PLAIN LANGUAGE SUMMARY Patients with epilepsy may require prolonged medical care. In Spain, care is provided by a range of specialist and non-specialist centers. In this study, a team of Spanish neurologists, nurses, patients and caregivers identified barriers that affect the delivery of high-quality care for patients with epilepsy at each stage of their journey through the Spanish NHS. Specific epilepsy training for healthcare providers, appropriate resources for diagnosing and treating patients, and good communication between healthcare workers and patients were identified as important factors in providing high-quality care for patients with epilepsy.
Collapse
Affiliation(s)
- Juan José Poza
- Department of NeurologyDonostia University HospitalDonostia, San SebastiánSpain
| | | | | | - FEDE
- FEDE, Federación Española de EpilepsiaMadridSpain
| | | | - Ángel Aledo‐Serrano
- Epilepsy UnitVithas La Milagrosa University Hospital, Vithas Hospital GroupMadridSpain
| | | |
Collapse
|
3
|
Panahi P, Mirzohreh ST, Zafardoust H, Khamnian Z, Alizadeh M. Navigating the waves: A systematic review of telemedicine interventions and health service access challenges in epilepsy during COVID-19. Epilepsy Behav 2024; 158:109934. [PMID: 39079379 DOI: 10.1016/j.yebeh.2024.109934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 05/13/2024] [Accepted: 06/30/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION The COVID-19 pandemic has dramatically reshaped the landscape of healthcare delivery, prompting a surge in the adoption of telemedicine as a means to ensure continuity of care. During the pandemic, patients with epilepsy experienced difficulties accessing healthcare and obtaining necessary medications, with a substantial percentage facing obstacles in acquiring anti-seizure medication and reaching healthcare professionals. Disruptions in the supply and distribution of medication, due to COVID-19-related actions, further caused more problems for people with epilepsy and their caregivers like increasing seizure frequency. The pandemic has also accelerated the adoption of telemedicine, with evidence suggesting its potential benefits in various medical fields. In this systematic review and meta-analysis, we aim to investigate the challenges faced by patients with epilepsy during the COVID-19 pandemic, including healthcare access and medication acquisition, as well as evaluate changes in seizure frequency. Additionally, we will synthesize existing evidence on the use of telemedicine to address the healthcare needs of these patients, exploring its advantages and limitations. METHODS This systematic review was prepared using PRISMA reporting guidelines. The databases searched were PubMed, Scopus, Web of Science, and Cochrane. Risk of Bias was assessed using Joanna Briggs Institute (JBI). Following rigorous application of eligibility criteria, relevant data, covering both telemedicine-related and health service access information, were methodically extracted and organized using Microsoft Excel spreadsheets. The analytical procedures were executed through the utilization of Comprehensive Meta-Analysis (CMA) software. RESULTS A total of 70 articles included in this review. Regarding difficulties in accessing healthcare, 34% of PWE and 41% of caregivers experienced cancelled, changed or postponed appointments. Following issues with obtaining medicine, 13% of patients and 16% of caregivers had difficulties in medicine availability and 11% of patients and 10% of caregivers in medicine accessibility. A very high rate of 90% satisfaction with telemedicine was reported by PWE. 17.6% of PWE experienced an escalation, 9% a decrease and 67% no changes in seizure frequency. CONCLUSION This review and meta-analysis revealed that telemedicine and virtual communications have been helpful but not sufficient for meeting healthcare needs for PWE during the COVID-19 pandemic. Additionally, there was a significant increase in seizure frequency among PWE who had difficulty obtaining medicine and access to healthcare.
Collapse
Affiliation(s)
| | | | | | - Zhila Khamnian
- Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahasti Alizadeh
- Faculty of Medicine, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Iran.
| |
Collapse
|
4
|
Abell K, Sit DK, Wisner KL. Depression in Persons With Epilepsy: Lessons From Case Review. J Clin Psychopharmacol 2024; 44:272-277. [PMID: 38684049 DOI: 10.1097/jcp.0000000000001848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Major depressive disorder is highly prevalent among persons with epilepsy (PWEs). Between 30% and 50% of PWEs suffer from depression. Many factors contribute to this prevalence, including the psychosocial impact of the diagnosis, restrictions on driving and certain types of work, and adverse effects associated with antiseizure medications. Without proper treatment, depressed PWEs have increased risks for suicide, strained relationships, lowered seizure control, and impairment in functioning. Our objective was to use the existing literature and insights from our experience in treating depression and anxiety in PWEs within an academic mood disorders center. We aimed to provide practical guidance for health care professionals who treat depression in this population. METHODS Persons with epilepsy and depression were identified by their treating psychiatrists. Their electronic health records were reviewed and compiled for this report, with a total of 12 included in this review. Records were reviewed regarding antiseizure medications, psychotropic medications, light therapy, psychotherapy, other interventions, and treatment response. RESULTS Based on our review of literature, as well as review of cases of individuals with epilepsy and comorbid psychiatric conditions, we recommend a step-wise evidence-based approach of optimizing psychiatric medication doses, augmenting with additional medication and/or implementing nonpharmacological interventions such as light therapy and psychotherapy. CONCLUSIONS In PWEs, improvement in depression, other psychiatric symptoms, and function are the goals of drug and nondrug interventions. Depression care has the potential to significantly improve the quality of life of PWEs and reduce both morbidity and mortality.
Collapse
Affiliation(s)
- Kathryn Abell
- From the Department of Psychiatry and Behavioral Health, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Dorothy K Sit
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Katherine L Wisner
- Developing Brain Institute, Children's National Hospital, Washington, DC
| |
Collapse
|
5
|
Lazaro MJ, Alvaran A, Yun MH, Kim S. Mobile Health Application for Seizure Management: A Human-Systems Integration Approach. HUMAN FACTORS 2024; 66:744-769. [PMID: 35337190 DOI: 10.1177/00187208221074427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The study aims to develop a mHealth application for seizure management based on the human system integration (HSI) approach. BACKGROUND Unmet healthcare needs among people with epilepsy continue to exist despite the advancement in healthcare technology. Current seizure management methods are found to be ineffective. Therefore, a more efficient strategy such as mHealth technology is necessary to aid seizure management. METHOD The needs identification phase involved identifying the user requirements by interviewing 10 stakeholders and conducting thematic analysis and needs interpretation technique. In the solution identification phase, the system requirements were derived using various human-centered design and systems engineering approaches and were evaluated through quality function deployment to determine design targets. For the design and evaluation phase, the design targets were reflected in the app through the iterative prototyping process, and the interface and functional design were evaluated by seven human factors and ergonomics experts and four stakeholders, respectively. RESULTS Three primary needs and ten user requirements were derived from the needs identification phase. Ten out of fifteen system requirements were selected as design targets to be included in the final prototype. Results of the evaluation showed that the interface design of the proposed app showed superior usability compared to a competitor app and that the app functions were beneficial for the stakeholders. CONCLUSION The mHealth app designed through the HSI framework showed good potential in addressing the main issues in seizure management. APPLICATION The mHealth app design methodology based on the HSI approach can be applied to the design of small-scale systems in various domains.
Collapse
Affiliation(s)
- May Jorella Lazaro
- Interdisciplinary Program in Cognitive Science, Seoul National University, South Korea
| | | | - Myung Hwan Yun
- Department of Industrial Engineering & Institute for Industrial System Innovation, Seoul National University, Seoul, Korea
| | - Sungho Kim
- Department of Systems Engineering, Republic of Korea Air Force Academy, South Korea
| |
Collapse
|
6
|
Buro AW, Sauls R, Salinas-Miranda A, Kirby RS. Socioecologic Factors Associated With Obesity in Adolescents With Epilepsy in the United States. J Child Neurol 2023; 38:642-652. [PMID: 37788353 DOI: 10.1177/08830738231203761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND Obesity among youth with epilepsy has multifactorial etiology, yet socioecologic obesity risk factors (eg, neighborhood factors) have not been examined in this population. This study examined (1) the prevalence of obesity adjusting for relevant covariates and (2) socioecologic correlates of obesity in adolescents with epilepsy aged 10-17 years. METHODS This cross-sectional study used 2017-2018 National Survey of Children's Health data (total n = 27,094; epilepsy n = 184). Chi-square tests compared weighted prevalence of obesity with relevant covariates among all adolescents and adolescents with epilepsy. Weighted multiple logistic regression models were conducted to adjust for covariates. RESULTS The prevalence of obesity in adolescents with epilepsy was 27.8% (95% confidence interval [CI] 15.4%-40.3%) vs 15.1% (95% CI 14.1%-16.2%) for the non-epilepsy group. Adolescents with epilepsy also had higher odds of obesity after adjusting for age, gender, race/ethnicity, household income, physical activity, and medical home (odds ratio [OR] 2.1, 95% CI 1.2-3.8). Adjusting for sociodemographics, anxiety (OR 4.5, 95% CI 1.3-15.6), 2 or more adverse childhood experiences (OR 7.3, 95% CI 1.6-33.4), neighborhood detracting elements (eg, OR 5.2, 95% CI 1.5-18.5 for 1 detracting element), and forgone care (ie, unmet health care needs) (OR 22.4, 95% CI 3.8-132.8) were associated with obesity in adolescents with epilepsy. Adjusting for multiple comparisons, neighborhood detracting elements (P < .0001) and forgone care (P < .0007) remained significant. CONCLUSION Variables related to mental health, family functioning, built environment, and forgone care were associated with obesity in adolescents with epilepsy, but the association was not fully explained by these factors. Obesity interventions for this population should consider multiple levels of influence including the community and special health care needs of this population.
Collapse
Affiliation(s)
- Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- College of Population Health, University of New Mexico, Albuquerque, NM, USA
| | - Rachel Sauls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL, USA
| |
Collapse
|
7
|
Park MJ, Chung MY. Factors affecting unmet healthcare needs in female baby boomers: Andersen model application in Korea. PLoS One 2023; 18:e0286425. [PMID: 37262054 DOI: 10.1371/journal.pone.0286425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
This study aimed to measure unmet healthcare needs and investigate the factors affecting them in female baby boomers (individuals born between 1955 and 1963) using the Korea Health Panel Data 2017 from February to June 2017 by the Korea Institute for Health and Social Affairs and the National Health Insurance Corporation. The data were analyzed using descriptive statistics, chi-square test, t-test, and multiple logistic regression using SPSS WIN 25.0 program. The results showed that the proportion of unmet healthcare needs was 11.1%, and the primary reason for unmet healthcare needs was the lack of visitation time. Female baby boomers experienced more unmet healthcare needs when they had no spouse (1.63 times), eating problems (2.33 times), and stress (1.31 times). This study is significant because it measured the unmet healthcare needs of women in the baby boomer generation and identified the factors influencing unmet healthcare needs. The study's results can help provide essential data to decrease the unmet healthcare needs of female baby boomers.
Collapse
Affiliation(s)
- Min-Jeong Park
- Department of Nursing, Kunsan National University, Kunsan-si, Korea
| | - Mi-Young Chung
- Department of Nursing Science, Sunmoon University, Asan-si, Korea
| |
Collapse
|
8
|
Roghani A, Bouldin E, Mobasher H, Kalvesmaki A, Panahi S, Henion A, VanCott A, Raquel Lopez M, Jo Pugh M. COVID-19 pandemic experiences among people with epilepsy: Effect on symptoms of co-occurring health conditions and fear of seizure. Epilepsy Behav 2023; 144:109206. [PMID: 37236022 DOI: 10.1016/j.yebeh.2023.109206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The Coronavirus disease 2019 (COVID-19) pandemic profoundly affected people worldwide, but little is known about how it impacted people with epilepsy (PWE). We examined the associations between COVID-19 stressors and health outcomes including increases in other health symptoms and fear of seizure among PWE. METHODS This cross-sectional study used data from an online survey that asked about demographic characteristics, health conditions, and potential life stressors during COVID-19. Data were collected from October 30 to December 8, 2020. COVID-19 stressors were anger, anxiety, stress, healthcare access, fear of seeking healthcare, social isolation, sense of control over their lives, and alcohol consumption. A binary variable was created for each of these measures to indicate whether PWEs experienced a negative change versus a neutral or positive change. We used multivariable logistic regression to assess the associations of COVID-19 stressors with primary outcomes: exacerbated co-occurring health conditions and increasing fear of seizure during the pandemic. RESULTS Of the 260 PWE included in the study, 165 (63.5%) were women; the average age was 38.7 years. During the survey administration period, 79 (30.3%) of the respondents reported exacerbated co-occurring health conditions, and 94 (36.2%) reported an increased fear of seizures. Regression results indicated that the fear of seeking healthcare during COVID-19 was associated with both exacerbated co-occurring health conditions (aOR 1.12; 95%CI 1.01-1.26) and increasing fear of seizure (aOR 2.31; 95%CI 1.14-4.68). Social isolation was associated with exacerbated co-occurring health conditions during COVID-19 (aOR 1.14; 95%CI 1.01-1.29). Reduced access to physical healthcare was associated with increasing fear of seizure (aOR 2.58; 95%CI 1.15-5.78). CONCLUSION A considerable number of PWE experienced more symptoms of existing health conditions and fear of seizure during the initial year of the pandemic (2020). Fear of seeking healthcare services was associated with both negative outcomes. Assuring access to health care and reducing social isolation could potentially reduce negative outcomes for PWE. It is necessary to provide adequate support for PWE to reduce risks as COVID-19 continues to be a health concern.
Collapse
Affiliation(s)
- Ali Roghani
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erin Bouldin
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Helal Mobasher
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrea Kalvesmaki
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA; VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Samin Panahi
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA; VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Amy Henion
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Anne VanCott
- VA Pittsburgh Health Care System, Pittsburgh, PA, USA; Department of Neurology, Epilepsy Division University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria Raquel Lopez
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Jo Pugh
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA; VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Munger Clary HM, Giambarberi L, Floyd WN, Hamberger MJ. Afraid to go out: Poor quality of life with phobic anxiety in a large cross-sectional adult epilepsy center sample. Epilepsy Res 2023; 190:107092. [PMID: 36701931 PMCID: PMC10167591 DOI: 10.1016/j.eplepsyres.2023.107092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/05/2022] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE People with epilepsy (PWE) have unmet healthcare needs, especially in the context of mental health. Although the current literature has established increased incidence of anxiety and depression in PWE and their contribution to poor quality of life, little is known regarding the presence and impact of specific phobia and agoraphobia. Our aim was to assess factors associated with high phobic/agoraphobic symptoms in a large, single tertiary epilepsy center sample, and to assess their impact on quality of life. METHODS In a diverse sample of 420 adults with epilepsy, cross-sectional association of demographic, epilepsy and cognitive factors with high phobic symptoms were assessed using multiple logistic regression. Symptoms were measured with the SCL-90R validated self-report subscale (T-score ≥ 60 considered high phobic symptom group). Multiple logistic regression modeling was used to assess for independent association of demographic and clinical variables with presence of high phobic symptoms, and multiple linear regression modeling was used to evaluate for independent cross-sectional associations with epilepsy-specific quality of life (QOLIE-89). RESULTS Lower education (adjusted OR 3.38), non-White race/ethnicity (adjusted OR 2.34), and generalized anxiety symptoms (adjusted OR 1.91) were independently associated with high phobic/agoraphobic symptoms, all p < 0.005. Phobic/agoraphobic symptoms were independently associated with poor quality of life as were depression symptoms, older age, and non-White race/ethnicity. Generalized anxiety did not demonstrate a significant independent association with quality of life in the multivariable model. CONCLUSION In this study sample, phobic/agoraphobic symptoms were independently associated with poor quality of life. Clinicians should consider using more global symptom screening instruments with particular attention to susceptible populations, as these impactful symptoms may be overlooked using generalized-anxiety focused screening paradigms.
Collapse
Affiliation(s)
- Heidi M Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | - Luciana Giambarberi
- Department of Psychiatry, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | - Whitney N Floyd
- Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | - Marla J Hamberger
- Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA.
| |
Collapse
|
10
|
Graham-Rowe E, Katzer CB, Riaz S, Attwood A, Bates L, Sainz-Fuertes R, Swan B. Unmet needs of people with epilepsy: A qualitative study exploring their journey from presentation to long-term management across five European countries. Front Neurol 2023; 14:1130817. [PMID: 37122296 PMCID: PMC10140522 DOI: 10.3389/fneur.2023.1130817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Epilepsy is a neurological disease that can negatively impact a person's physical, psychological, social, and emotional well-being. The aim of this study was to provide insights into the experiences of people with epilepsy on polytherapy (i.e., people on a combination of two or more anti-seizure medications [ASMs]), with an emphasis on their emotional journey. Methods Market research was conducted with 40 people with epilepsy from France, Germany, Italy, Spain, and the United Kingdom. Semi-structured interviews were analyzed using both a content and framework analysis approach. A content analysis of participants' expressed emotions was used to illustrate the changes of emotions experienced by people with epilepsy from presentation through to monitoring and follow-up stages. Results In each stage of the journey, themes and subthemes were identified under the overarching headings: Stage 1: Presentation - Life is turned upside down; Stage 2: Diagnosis - Period of learning; Stage 3: Treatment - Aspirations and experimentation; and Stage 4: Monitoring and follow-up - Feeling "out on a limb". The research identified key unmet needs and opportunities for people with epilepsy to improve their subjective experiences at different stages of their disease journey, namely: (1) establish and promote support networks from presentation through to monitoring and follow-up stages; (2) accelerate pathway to diagnosis; (3) provide opportunities to discuss the diagnosis with patients; (4) clarify treatment-change guidelines for patients; and (5) develop a shared treatment decision-making/empowerment tool. Discussion The research findings and recommendations have the potential to drive change at an individual level, as well as at a healthcare level.
Collapse
Affiliation(s)
- Ella Graham-Rowe
- OPEN Health Communications LLP, Marlow, Buckinghamshire, United Kingdom
| | | | - Sumira Riaz
- OPEN Health Communications LLP, Marlow, Buckinghamshire, United Kingdom
| | - Amanda Attwood
- OPEN Health Communications LLP, Marlow, Buckinghamshire, United Kingdom
| | - Liz Bates
- Eisai Europe Ltd, Hatfield, United Kingdom
| | | | - Becky Swan
- Eisai Europe Ltd, Hatfield, United Kingdom
- *Correspondence: Becky Swan,
| |
Collapse
|
11
|
Khattar J, Griffith LE, Jones A, De Rubeis V, de Groh M, Jiang Y, Basta NE, Kirkland S, Wolfson C, Raina P, Anderson LN. Symptoms of depression and anxiety, and unmet healthcare needs in adults during the COVID-19 pandemic: a cross-sectional study from the Canadian Longitudinal Study on Aging. BMC Public Health 2022; 22:2242. [PMID: 36456993 PMCID: PMC9713148 DOI: 10.1186/s12889-022-14633-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted access to healthcare services in Canada. Research prior to the pandemic has found that depression and anxiety symptoms were associated with increased unmet healthcare needs. The primary objective of this study was to examine if mental health was associated with perceived access to healthcare during the pandemic METHODS: A cross-sectional study was conducted using data from 23,972 participants (aged 50-96) in the Canadian Longitudinal Study on Aging COVID-19 Exit Survey (Sept-Dec 2020). We used logistic regression to estimate how the presence of depression and anxiety symptoms, defined using scores of ≥10 on the Center for Epidemiologic Studies Depression Scale and ≥10 on the Generalized Anxiety Disorder Scale, were associated with the odds of reporting: 1) challenges accessing healthcare, 2) not going to a hospital or seeing a doctor when needed, 3) experiencing barriers to COVID-19 testing. Models were adjusted for sex, age, region, urban/rural residence, racial background, immigrant status, income, marital status, work status, chronic conditions, and pre-pandemic unmet needs. RESULTS The presence of depressive (aOR=1.96; 95% CI=1.82, 2.11) and anxiety symptoms (aOR=2.33; 95% CI=2.04, 2.66) compared to the absence of these symptoms were independently associated with higher odds of challenges accessing healthcare. A statistically significant interaction with sex suggested stronger associations in females with anxiety. Symptoms of depression (aOR=2.88; 95% CI=2.58, 3.21) and anxiety (aOR=3.05; 95% CI=2.58, 3.60) were also associated with increased odds of not going to a hospital or seeing a doctor when needed. Lastly, depressive (aOR=1.99; 95% CI=1.71, 2.31) and anxiety symptoms (aOR=2.01; 95% CI=1.58, 2.56) were associated with higher odds of reporting barriers to COVID-19 testing. There was no significantly significant interaction with sex for the latter two outcomes. CONCLUSION The presence of depression and anxiety symptoms were strongly associated with perceived unmet healthcare needs during the COVID-19 pandemic. Interventions to improve healthcare access for adults with depression and anxiety during the pandemic may be necessary.
Collapse
Affiliation(s)
- Jayati Khattar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - Vanessa De Rubeis
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - Margaret de Groh
- Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, K0A 0K9, Canada
| | - Ying Jiang
- Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, K0A 0K9, Canada
| | - Nicole E Basta
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Canada
| | - Susan Kirkland
- Department of Community Health & Epidemiology and Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health & Department of Medicine, McGill University, Montreal Canada & Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada.
| |
Collapse
|
12
|
Salom R, Aras LM, Piñero J, Duñabeitia JA. Validation of Childhood Rare Epilepsy Social Impact Assessment (CRESIA) to Measure the Social and Family Impact of Rare Childhood Diseases with Epilepsy. J Clin Med 2022; 11:jcm11226720. [PMID: 36431197 PMCID: PMC9695819 DOI: 10.3390/jcm11226720] [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: 10/21/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
This study addresses the social relevance of low-prevalence childhood diseases and reports the process of generation and validation of a tool to assess the social impact on the direct family environment and the social context of reference. The aim of the process of construction and validation of this instrument is to provide the field with a tool with the capacity to shed light on the social consequences of suffering from a low-prevalence disease, specifically those comorbid with treatment-resistant epileptic seizures of childhood origin. The instrument here presented and called CRESIA (acronym derived from Childhood Rare Epilepsy Social Impact Assessment) provides valuable information on six specific areas framing health, economic, psychological, social, and child-related stressors, as well as family. CRESIA represents a valid and reliable instrument for family members or primary caregivers of children and adolescents with childhood rare epilepsy.
Collapse
Affiliation(s)
- Rafael Salom
- Centro de Investigación Nebrija en Cognición (CINC), Facultad de Lenguas y Educación, Universidad Nebrija, 28248 Madrid, Spain
- Asociación ApoyoDravet, 20009 San Sebastián, Spain
| | - Luis Miguel Aras
- Asociación ApoyoDravet, 20009 San Sebastián, Spain
- Servicio Navarro de Salud-Osasunbidea, 31010 Navarra, Spain
| | - Jessica Piñero
- Centro de Investigación Nebrija en Cognición (CINC), Facultad de Lenguas y Educación, Universidad Nebrija, 28248 Madrid, Spain
- Fundación Salud Infantil, 03201 Elche, Spain
| | - Jon Andoni Duñabeitia
- Centro de Investigación Nebrija en Cognición (CINC), Facultad de Lenguas y Educación, Universidad Nebrija, 28248 Madrid, Spain
- AcqVA Aurora Center, Department of Languages and Culture, UiT the Arctic University of Norway, 9019 Tromsø, Norway
- Correspondence:
| |
Collapse
|
13
|
Behavioral health screening in pediatric epilepsy: Which measures commonly used in the United States are 'good enough'? Epilepsy Behav 2022; 134:108818. [PMID: 35841809 DOI: 10.1016/j.yebeh.2022.108818] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To improve evidence-based implementation of behavioral health screening measures in pediatric epilepsy care, guidance is needed in the selection and interpretation of evidence-based screening measures. Therefore, the goals of this project were to (1) evaluate the clinical utility and psychometric properties of screening instruments frequently used in the United States (US) for anxiety, depression, and behavior problems in youth with epilepsy (YWE), and (2) provide guidance around selection and interpretation of these behavioral health screening measures. METHOD The critique was conducted in three phases: (1) identification of articles based on search criteria; (2) full review of articles for eligibility assessment; (3) evaluation of screening measures and organization into Tiers. Nine behavioral health measures frequently used to screen for anxiety, depression, and disruptive behaviors in the US were selected for evaluation. PubMed, CINAHL, Medline, and APA databases were searched using the following search terms: [target area] + [screening measure] + epilepsy + children [youth], [adolescents]. Inclusion/exclusion criteria for articles were as follows: (1) focused on YWE, (2) written in English, and (3) conducted in the US. Once articles were selected, Hunsley and Mash's criteria were used to evaluate and categorize the screening measures' psychometric properties, which have clear relevance to clinical practice. Measures were also classified into three tiers by the level of validation according to established evidence-based criteria. RESULTS Forty-one unique papers were identified through the literature search and assessed as eligible. Evaluation of screening measures revealed only two psychometrically sound measures that met criteria for Tier 1, the NDDI-E-Y and the Pediatric NeuroQoL-Depression, both depression screening measures. Several additional depression screening measures met criteria for Tier 2 (CDI-2, BASC-2-Depression Scale, and CBCL Withdrawn/Depressed Scale). Anxiety screening measures have not been validated in pediatric epilepsy and thus only met the criteria for Tier 2 (BASC-2 Anxiety Scale, CBCL DSM-IV Oriented Anxiety Problems Scale, MASC). Similarly for disruptive behaviors, two measures met Tier 2 criteria (BASC-2 Externalizing Problems Index, CBCL Externalizing Problems Index). CONCLUSION Strides have been made in the validation of behavioral health screening measures for YWE; however, continued research in this area is necessary to validate existing psychometrically sound measures and to develop and evaluate epilepsy-specific measures in the pediatric epilepsy population.
Collapse
|
14
|
Chittem M, Kelada L, Muppavaram N, Lingappa L, Wakefield CE. Unmet and under-met needs among Indian parents of children with neurological disorders. J Pediatr Nurs 2022; 63:e1-e9. [PMID: 34848111 DOI: 10.1016/j.pedn.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Parents of children with neurological disorders commonly report having unmet needs related to their child's care. Mixed methods research is needed with parents of children with neurological disorders in India in order to: 1) quantify which needs are unmet and under-met, and 2) qualitatively explore how parents perceive their unmet and under-met needs. METHODS This concurrent mixed-methods study used a convergence model of triangulation design. Parents of children with neurological disorders receiving treatment in a children's hospital in Hyderabad, India completed questionnaires (n = 205) on unmet/under-met needs. Twenty-five of these parents then completed in-depth interviews exploring experiential aspects of unmet needs. RESULTS Quantitative analysis suggested that education about the child's illness and medical needs were the most frequent unmet needs. Parents needed their child's condition explained to them (91.7%) and greater continuity of their child's care (85.4%). Qualitative analysis suggested that parents reported struggling to find a specialist who was knowledgeable about their child's condition. Though parents living in rural areas quantitatively reported fewer unmet needs (child's medical care, care coordination, and communication) than parents living in the city (B = 0.92 [95%CI = 0.64,1.20] for medical care needs), the qualitative data showed this may be due to lower expectations from the health system. CONCLUSION Parents of children with neurological disorders in India frequently report unmet and under-met needs. PRACTICE IMPLICATIONS Community-based interventions coupled with training nurses on information provision could help bridge the gap between what is offered by hospital systems, and what is needed by parents, in terms of information and support.
Collapse
Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India.
| | - Lauren Kelada
- School of Women's and Children's Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| | - Nagesh Muppavaram
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India
| | - Lokesh Lingappa
- Department of Neurology, Rainbow Children's Hospital, Hyderabad, India
| | - Claire Elizabeth Wakefield
- School of Women's and Children's Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| |
Collapse
|
15
|
Abstract
The development of mobile health for epilepsy has grown in the last years, bringing new applications (apps) to the market and improving already existing ones. In this systematic review, we analyse the scope of mobile apps for seizure detection and epilepsy self-management, with two research questions in mind: what are the characteristics of current solutions and do they meet users’ requirements? What should be considered when designing mobile health for epilepsy? We used PRISMA methodology to search within App Store and Google Play Store from February to April of 2021, reaching 55 potential apps. A more thorough analysis regarding particular features was performed on 26 of those apps. The content of these apps was evaluated in five categories, regarding if there was personalisable content; features related to medication management; what aspects of seizure log were present; what type of communication prevailed; and if there was any content related to seizure alarm or seizure action plans. Moreover, the 26 apps were evaluated through using MARS by six raters, including two neurologists. The analysis of MARS categories was performed for the top and bottom apps, to understand the core differences. Overall, the lowest MARS scores were related to engagement and information, which play a big part in long-term use, and previous studies raised the concern of assuring continuous use, especially in younger audiences. With that in mind, we identified conceptual improvement points, which were divided in three main topics: customisation, simplicity and healthcare connection. Moreover, we summarised some ideas to improve m-health apps catered around long-term adherence. We hope this work contributes to a better understanding of the current scope in mobile epilepsy management, endorsing healthcare professionals and developers to provide off-the-shelf solutions that engage patients and allows them to better manage their condition.
Collapse
|
16
|
Gilkinson C, Kinney M, Olaniyan T, Murtala B, Sipilon M, Malunga A, Joof SM, Shankar R. Perceptions about mental healthcare for people with epilepsy in Africa. Epilepsy Behav 2022; 127:108504. [PMID: 34954510 DOI: 10.1016/j.yebeh.2021.108504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/27/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mental illness is commonly comorbid with epilepsy. In sub-Saharan Africa there exists limited access to neurological and psychiatric services predisposing to a "treatment gap" in epilepsy and mental healthcare. AIMS To understand healthcare providers' knowledge, attitudes, and management practices toward epilepsy and comorbid mental illness in sub-Saharan Africa. METHODS A cross-sectional online survey following the STROBE guidance was conducted among healthcare providers in sub-Saharan Africa. Eleven questions looking to ascertain clinician demographics, knowledge of epilepsy, and comorbid mental illness as well as management practices were developed. FINDINGS Of 203 responses most (92%) respondents recognized a bi-directional relationship between mental health and epilepsy. However, mental illness screening in people newly diagnosed with epilepsy was infrequently performed (14%). Only 1 in 7 (16%) respondents had high confidence in their clinical competence at managing psychiatric comorbidities. Most would value further training (74%) and improvements to be made in current management practices within their local healthcare settings (94%). CONCLUSIONS This pilot study highlights the need to improve the awareness of management of mental disorders in populations with epilepsy within sub-Saharan Africa in health providers there.
Collapse
Affiliation(s)
- Chloe Gilkinson
- Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | - Michael Kinney
- Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK; Belfast Health and Social Care Trust, UK
| | - Tolu Olaniyan
- Pretola Global Health Consulting Limited, Isle Of Wight, UK
| | - Bankole Murtala
- Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | | | | | - Sohna M Joof
- Edward Francis Small Teaching Hospital, Banjul, Gambia
| | - Rohit Shankar
- University of Plymouth, Peninsula School of Medicine, Truro, UK; Cornwall Partnership NHS Foundation Trust, Truro, UK.
| |
Collapse
|
17
|
Ma XP, Li YP, Yang R, Zhou D, Li JM. Challenges of patients with epilepsy and measures for improving epilepsy care in western China: A qualitative study. Epilepsy Res 2021; 178:106788. [PMID: 34844090 DOI: 10.1016/j.eplepsyres.2021.106788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this qualitative study was to explore the challenges that patients with epilepsy (PWEs) face and the opportunities or areas where changes in nursing care may improve epilepsy care in western China. METHODS Semi-structured interviews with open-ended questions based on a review of the literature were conducted at the epilepsy center of a tertiary hospital in western China. A total of 18 PWEs, 18 caregivers and 11 neurology nurses were interviewed by using purposive sampling. The data were transcribed verbatim, and a content analysis was used to conduct the framework analysis. RESULTS Three key themes were identified, namely, the impact of epilepsy, barriers to epilepsy management, and measures in nursing care for improving epilepsy care. Psychological stress, the side effects of drugs and accidental injury related to seizures were reported to be the main negative impacts on patients. Limited knowledge about epilepsy, poor adherence to therapy, and a lack of effective communication between patients and medical staff were the major barriers to epilepsy management. Strengthening health education, assessing the frequency and type of seizures, screening for psychological disorders and mental intervention, and maintaining continuity of care were identified as crucial measures for nurses to improve epilepsy care. CONCLUSIONS This study highlights the challenges among PWEs and opportunities for improving the quality of epilepsy care in western China. Limited knowledge and poor drug adherence are the main barriers to epilepsy management, which might be improved by more health education and continuing care provided by nurses. Assessing seizures, screening for psychological disorders and providing appropriate psychological care would help improve epilepsy care.
Collapse
Affiliation(s)
- Xue-Ping Ma
- West China School of Nursing, Sichuan University/ Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Yin-Ping Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Rong Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Jin-Mei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
| |
Collapse
|
18
|
Coughtrey AE, Bennett SD, Sibelli A, Chorpita B, Dalrymple E, Fonagy P, Ford T, Heyman I, Moss-Morris R, Mice Study Team, Ching BCF, Shafran R. "A greatest hits compilation of mental health support": A qualitative study of health professionals' perceptions of modular CBT in pediatric epilepsy services. Epilepsy Behav 2021; 123:108249. [PMID: 34464829 DOI: 10.1016/j.yebeh.2021.108249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The primary aim of this qualitative study was to explore the views of health professionals, with little previous clinical mental health training, of an adapted modular cognitive-behavioral intervention (MATCH-ADTC) for common mental health problems in children and young people with epilepsy. METHODS Healthcare Professionals (HCPs) and their supervisors were interviewed at the start (n = 23) and end (n = 15) of the six-month training period. The interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS Three higher order themes with sub-themes were identified: (1) strengths of the MATCH-ADTC content and manual; (2) expectations of the treatment; and (3) improving practice with MATCH-ADTC. Overall impressions of the training and treatment were largely positive, with HCPs viewing MATCH-ADTC as an acceptable treatment for the families that they worked with. HCPs highlighted some challenges in delivering an integrated service, particularly relating to the time commitment involved and their own confidence in delivering the intervention, as many participants did not have a mental health background. CONCLUSIONS The findings suggested that the intervention and training was acceptable to HCPs working in pediatric epilepsy services, and confidence grew over the six-month training period. Further research is needed to understand how to best train, supervise, and support HCPs in pediatric epilepsy services to deliver mental health treatments.
Collapse
Affiliation(s)
- Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK.
| | - Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Alice Sibelli
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE1 9RT, UK
| | - Bruce Chorpita
- Department of Psychology, UCLA, Los Angeles, CA 90095-1563, USA
| | - Emma Dalrymple
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Peter Fonagy
- Division of Psychology & Language Sciences, University College London, 26 Bedford Way, London WC1H 0AP, UK
| | - Tamsin Ford
- Department of Psychiatry, Cambridge University, Cambridge, UK; Cambridge and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Rona Moss-Morris
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE1 9RT, UK
| | - Mice Study Team
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Brian C F Ching
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
| |
Collapse
|
19
|
Beesley RE, Walton C, Hindley D, Jameson H, Panwar N, Lew AR. Carer evaluations of paediatric epilepsy services with and without epilepsy specialist nurse provision. Seizure 2021; 91:174-180. [PMID: 34174691 DOI: 10.1016/j.seizure.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/09/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare paediatric epilepsy services with and without Epilepsy Specialist Nurse (ESN) provision on measures of carer satisfaction and accessibility of service. METHODS In Study 1, carers in Northern England (n = 69 with an ESN, n = 27 without an ESN), completed the Parent Report of Psychosocial Care Scale to measure satisfaction with service provision. A measure of accessibility of service was also included. In Study 2, in depth semi-structured interviews with 58 carers (51 of whom had also participated in Study 1) were examined for talk related to accessibility of service. RESULTS In Study 1, Satisfaction with service levels were high across all areas, (ESN areas Mdn = 9.04, IQR = 1.48, non-ESN areas Mdn = 8.29, IQR = 2.41; maximum score = 10), but with carers from ESN areas over 3 times more likely to endorse scores at the median or above relative to non-ESN areas (OR = 3.28). For accessibility, carers in ESN areas were over 5 times more likely to have a median score or higher (ESN areas Mdn = 10, IQR = 0.45, non-ESN areas Mdn = 8.4, IQR = 5, OR = 5.43). In study 2 a majority of all carers reported having made at least one attempt to contact services between appointments, for a wide range of reasons, with timely resolution reported in ESN areas, but more variable resolution occurring in non-ESN areas. CONCLUSION Paediatric ESNs provide a critical and timely service to children with epilepsy and their carers.
Collapse
Affiliation(s)
- Rebekah E Beesley
- Psychology Department, Fylde College, Lancaster University, Lancaster LA1 4YF, United Kingdom.
| | - Chris Walton
- Psychology Department, Fylde College, Lancaster University, Lancaster LA1 4YF, United Kingdom.
| | - Daniel Hindley
- Bolton NHS Foundation Trust, Breightmet Health Centre, Breightmet Fold Lane, Bolton BL2 6NT, United Kingdom.
| | - Helen Jameson
- Bolton NHS Foundation Trust, Breightmet Health Centre, Breightmet Fold Lane, Bolton BL2 6NT, United Kingdom.
| | - Nitin Panwar
- Manchester University Foundation Trust, 1st Floor, Universal Sq., Devonshire St. North, Manchester, M12 6JH, United Kingdom.
| | - Adina R Lew
- Psychology Department, Fylde College, Lancaster University, Lancaster LA1 4YF, United Kingdom.
| |
Collapse
|
20
|
Jung B, Ha IH. Determining the reasons for unmet healthcare needs in South Korea: a secondary data analysis. Health Qual Life Outcomes 2021; 19:99. [PMID: 33743725 PMCID: PMC7981839 DOI: 10.1186/s12955-021-01737-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background “Unmet healthcare needs” refers to the situation in which patients or citizens cannot fulfill their medical needs, likely due to socioeconomic reasons. The purpose of this study was to analyze factors related to unmet healthcare needs among South Korean adults. Methods We used a retrospective cross-sectional study design. This nationwide-based study included the data of 26,598 participants aged 19 years and older, which were obtained from the 2013–2017 Korea National Health and Nutrition Examination Surveys. Using multiple logistic regression models, we analyzed the associations between factors that influence unmet healthcare needs and participants’ subgroups. Results Despite South Korea’s universal health insurance system, in 2017, 9.5% of South Koreans experienced unmet healthcare needs. In both the male and female groups, younger people (age 19–39) had a higher odds ratio (OR) of experiencing unmet healthcare needs compared to older people (reference: age ≥ 60) (men: OR 1.83, 95% confidence interval [CI] = 1.35–2.48; women: OR 1.42, 95% CI 1.12–1.81). In particular, unlike men, women’s unmet healthcare needs increased as their incomes decreased (1 quartile OR 1.55, 2 quartiles OR 1.29, 3 quartiles OR 1.26). Men and women showed a tendency to have more unmet healthcare needs with less exercise, worse subjective health state, worse pain, and a higher degree of depression. Conclusions The contributing factors of unmet healthcare needs included having a low socioeconomic status, high stress, severe pain, and severe depression. Considering our findings, we suggest improving healthcare access for those with low socioeconomic status. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01737-5.
Collapse
Affiliation(s)
- Boyoung Jung
- Department of Health Administration, Hanyang Women's University, 200 Salgoji-gil, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 3F, 538 Gangnam-daero, Gangnam-gu, Seoul, 06110, Republic of Korea.
| |
Collapse
|
21
|
Bennett SD, Cross JH, Coughtrey AE, Heyman I, Ford T, Chorpita B, Moss-Morris R, Byford S, Dalrymple E, Reilly C, Stephenson T, Doré C, Varadkar S, Blackstone J, Chowdhury K, Ganguli P, Deane L, Shafran R. M.I.C.E-Mental Health Intervention for Children with Epilepsy: a randomised controlled, multi-centre clinical trial evaluating the clinical and cost-effectiveness of MATCH-ADTC in addition to usual care compared to usual care alone for children and young people with common mental health disorders and epilepsy-study protocol. Trials 2021; 22:132. [PMID: 33573674 PMCID: PMC7876975 DOI: 10.1186/s13063-020-05003-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health disorders in the context of long-term conditions in children and young people are currently overlooked and undertreated. Evidence-based psychological treatments for common childhood mental health disorders (anxiety, depression and disruptive behaviour disorders) have not been systematically evaluated in young people with epilepsy despite their high prevalence in this population. The aim of this multi-site randomised controlled trial is to determine the clinical and cost-effectiveness of adding a modular psychological intervention to usual care for the mental health disorders in comparison to assessment-enhanced usual care alone. METHODS In total, 334 participants aged 3-18 years attending epilepsy services will be screened for mental health disorders with the Strengths and Difficulties Questionnaire (SDQ) and the diagnostic Development and Wellbeing Assessment (DAWBA). Those identified as having a mental health disorder and consenting to the trial will be randomised to either receive up to 22 sessions of the modular psychological intervention (MATCH-ADTC) delivered over the telephone over 6 months by non-mental health professionals in addition to usual care or to assessment-enhanced usual care alone. Outcomes will be measured at baseline, 6 months and 12 months post-randomisation. It is hypothesised that MATCH-ADTC plus usual care will be superior to assessment-enhanced usual care in improving emotional and behavioural symptoms. The primary outcome is the SDQ reported by parents at 6 months. Secondary outcomes include parent-reported mental health measures such as the Revised Children's Anxiety and Depression Scale, quality of life measures such as the Paediatric Quality of Life Inventory and physical health measures such as the Hague Seizure Severity Scale. Outcome assessors will be blinded to group assignment. Qualitative process evaluations and a health economic evaluation will also be completed. DISCUSSION This trial aims to determine whether a systematic and integrated approach to the identification and treatment of mental health disorders in children and young people with epilepsy is clinically and cost-effective. The findings will contribute to policies and practice with regard to addressing mental health needs in children and young people with other long-term conditions. TRIAL REGISTRATION ISRCTN ISRCTN57823197 . Registered on 25 February 2019.
Collapse
Affiliation(s)
- Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - J Helen Cross
- Great Ormond Street Hospital NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Department of Psychiatry, Cambridge University, Cambridge, UK.,Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Rona Moss-Morris
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emma Dalrymple
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Colin Reilly
- National Centre for Young People with Epilepsy, Surrey, UK
| | - Terence Stephenson
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Caroline Doré
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Sophia Varadkar
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - James Blackstone
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Kashfia Chowdhury
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Poushali Ganguli
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Liz Deane
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | | | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. .,Great Ormond Street Hospital NHS Foundation Trust, London, UK.
| |
Collapse
|
22
|
Kaddumukasa M, Smith PJ, Kaddumukasa MN, Kajumba M, Almojuela A, Bobholz S, Chakraborty P, Sinha DD, Nakasujja N, Kakooza-Mwesige A, Gualtieri A, Onuoha E, Nakku J, Sanchez N, Muhumuza C, Fuller AT, Haglund MM, Koltai DC. Epilepsy beliefs and misconceptions among patient and community samples in Uganda. Epilepsy Behav 2021; 114:107300. [PMID: 32758405 DOI: 10.1016/j.yebeh.2020.107300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of the study was to characterize and compare the attitudes, beliefs, and perceptions about epilepsy across community and patient cohorts in Uganda. METHODS This was a descriptive study utilizing two samples: a randomly selected, national survey community sample and a hospital-based patient sample of people with epilepsy (PWE) and their caregivers attending clinic settings in Kampala and Mbarara, Uganda for epilepsy care. Both samples were surveyed about their beliefs about epilepsy, its treatment, and people who have the illness. Multivariate linear regression was used to examine group differences and variables associated with specific beliefs. RESULTS Among the 15,818 community survey participants who participated in this study, 435 study participants reported symptoms suggestive of recurrent seizures, and all 626 subjects in the hospital-based sample had confirmed epilepsy. Results revealed significant differences across groups in their endorsement of epilepsy as a contagion; 37% of people in the community unaffected by epilepsy, and 39% of people with suspected epilepsy who did not seek care believed that epilepsy was contagious by touch, in contrast to 8% of PWE or their caregivers attending regular hospital-based care. Higher educational attainment and income, and seeking regular hospital-based medical care were associated with less endorsement of epilepsy as a contagion, while age, education, income, area of residence, and presence of seizure symptoms, were significant predictors of support or belief in the basic rights of PWE. Study participants within the community who screened negative for seizures placed the most restrictions on rights for PWE. To varying degrees, the samples all endorsed the effectiveness of allopathic, traditional, and religious providers, and the use of pharmaceutical drugs, traditional rituals and herbs, and prayer. CONCLUSIONS People with epilepsy who are attending biomedical care for routine epilepsy care think differently about epilepsy, its treatment, and the rights of those with the disease than the general population. Within the community setting, more erroneous beliefs and negative attitudes about epilepsy and PWE persist, and they not only contribute to stigma but also interfere with the patients' health-seeking behavior. Further confounding the care of PWE, the pluralistic healthcare system in Uganda is evident in endorsements spanning biomedical, traditional, and religious treatment methods. Focused awareness campaigns utilizing local epilepsy societies are needed to promote epilepsy health literacy, to favorably impact acceptance and opportunities for PWE in Uganda, and to facilitate efficient uptake of biomedical care. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
Collapse
Affiliation(s)
- Mark Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Patrick J Smith
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119; Trent Drive, Durham, NC, USA
| | - Martin N Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda; Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda
| | - Mayanja Kajumba
- Department of Mental Health and Community Psychology, Makerere University School of Psychology, P.O. Box 7062, Kampala, Uganda
| | - Alysa Almojuela
- Section of Neurosurgery, Rady Faculty of Health Sciences, University of Manitoba, GB1-820 Sherbrook Street, Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada
| | - Samuel Bobholz
- University of Wisconsin - Madison, Department of Neurology, 1685 Highland Avenue, Madison, WI 53705-2281, USA
| | - Payal Chakraborty
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Drishti D Sinha
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O.Box 7072, Kampala, Uganda; Department of Paediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Alex Gualtieri
- Duke University Medical Center, Clinical Neuropsychology Service, Box 3333, Durham, NC, USA
| | - Erica Onuoha
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Juliet Nakku
- Butabika National Referral Mental Hospital, P.O.Box 7017, Kampala, Uganda
| | - Nadine Sanchez
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Christine Muhumuza
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Makerere University School of Public Health, Department of Epidemiology and Biostatistics, New Mulago Complex, P.O. Box 7072, Kampala, Uganda
| | - Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, 3100 Tower Blvd, Durham, NC 27707, USA
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, 3100 Tower Blvd, Durham, NC 27707, USA
| | - Deborah C Koltai
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119; Trent Drive, Durham, NC, USA; Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA.
| |
Collapse
|
23
|
Stefanidou M, Greenlaw C, Douglass LM. Mental Health Issues in Transition-Age Adolescents and Young Adults With Epilepsy. Semin Pediatr Neurol 2020; 36:100856. [PMID: 33308524 DOI: 10.1016/j.spen.2020.100856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mental health disorders are prevalent in patients with epilepsy, and adolescents are at particularly high risk. The reason for higher rates of anxiety, depression and suicide in young patients with epilepsy is likely multifactorial, and therefore the approach to treatment has proven challenging. In this review, we discuss important mental health topics for adolescents and young adults with epilepsy, as well as evidence for management. In the past several years, advances have been made in the transition of epilepsy care from pediatric to adult providers, creating a promising method for epilepsy patient engagement and empowerment. Future research into the mental health outcomes from these transition programs may lead to better strategies to support young patients with epilepsy.
Collapse
Affiliation(s)
- Maria Stefanidou
- Department of Neurology, Boston University School of Medicine, Boston, MA.
| | - Celia Greenlaw
- Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center, Boston, MA
| | - Laurie M Douglass
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center, Boston, MA
| |
Collapse
|
24
|
Nevin SM, Wakefield CE, Schilstra CE, McGill BC, Bye A, Palmer EE. The information needs of parents of children with early-onset epilepsy: A systematic review. Epilepsy Behav 2020; 112:107382. [PMID: 32854014 DOI: 10.1016/j.yebeh.2020.107382] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Early-onset epilepsy has broad physical and psychosocial impacts, and parents have a wide variety of information needs. This systematic review set out to assess 1) whether parents of children with early-onset epilepsy have unmet information needs and 2) their preferences regarding information content and style of information delivery. METHODS We searched Medline, Embase, PsychInfo, and CINAHL using keywords relating to information needs, information resources, and preferences for information delivery. We limited the search to parent populations and included all peer-reviewed publications published in English after the year 2005. RESULTS Eleven studies met our inclusion criteria. Parents reported a clear need for understandable, realistic, and focused information, highlighting a particular need for content about comorbidities and emotional support. Parents reported limited availability of detailed information resources on early-onset epilepsy, which compromised their ability to access appropriate healthcare services. Unmet information needs were associated with greater levels of stress, poorer psychosocial outcomes, and lower satisfaction with healthcare services. SIGNIFICANCE The results highlight the importance of detailed epilepsy information for families. Healthcare professionals should be aware of the impact of a lack of epilepsy information on family wellbeing. Multipronged and tailored interventions targeting the information needs of families are warranted.
Collapse
Affiliation(s)
- Suzanne M Nevin
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.
| | - Clarissa E Schilstra
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Brittany C McGill
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Ann Bye
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Elizabeth E Palmer
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, Australia
| |
Collapse
|
25
|
Tombini M, Assenza G, Quintiliani L, Ricci L, Lanzone J, Ulivi M, Di Lazzaro V. Depressive symptoms and difficulties in emotion regulation in adult patients with epilepsy: Association with quality of life and stigma. Epilepsy Behav 2020; 107:107073. [PMID: 32320931 DOI: 10.1016/j.yebeh.2020.107073] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of the study was to assess depressive symptoms (DS) and difficulties in emotion regulation (ER) in adult people with epilepsy (PWE) and their correlation with quality of life and stigmatization feelings of patients. MATERIALS AND METHODS We enrolled consecutively 110 PWE who completed the Beck Depression Inventory-II (BDI-II) questionnaire and, for the first time, the Italian translation of Difficulties in Emotion Regulation Scale (DERS) to evaluate DS and ER. They also fulfilled the Italian version of the Stigma Scale of Epilepsy (SSE), which allowed the quantification of the stigma perception by our cohort of patients and a 3-item Jacoby's Stigma Scale (JSS) and QOLIE-31 (Q31) for the evaluation of stigma and the quality of life. The results of BDI-II and DERS were correlated with clinical details of PWE, as well as the Q31 and SSE scores. Finally, a multiple stepwise regression analysis was applied to identify the main factors affecting DS and ER difficulties in these patients. RESULTS About 30% of PWE evidenced DS, of which 17.3% showed a BDI-II score higher than 19, suggestive of moderate to severe DS. Several factors related to epilepsy (seizure frequency, number of antiepileptic drugs (AEDs)) as well as ER and quality of life/stigmatization perception resulted significantly correlated with DS. As a new finding, the main factors affecting DS in PWE turned out to be the difficulties in ER and quality of life and stigma perception (as evaluated through Q31 and JSS scores). CONCLUSIONS Our findings evidenced that DS in PWE are highly prevalent and strongly correlated with ER difficulties that mostly influence DS together with quality of life and stigma perception. Depressive symptoms and emotion dysregulation are linked by a bidirectional relationship and are significantly associated with worse quality of life and higher stigmatization feelings.
Collapse
Affiliation(s)
- Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy.
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Livia Quintiliani
- Psicologia Clinica, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Jacopo Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Martina Ulivi
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| |
Collapse
|
26
|
Antunes M, Ramos LM, Lourenço Ó, Quintal C. [Access to healthcare in Portugal in the wake of the crisis. Not everything is money?]. CAD SAUDE PUBLICA 2020; 36:e00248418. [PMID: 32022179 DOI: 10.1590/0102-311x00248418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/22/2019] [Indexed: 11/21/2022] Open
Abstract
Unmet healthcare needs have been used to assess access to healthcare. In scenarios of recession and financial constraints on public policies, it is important to identify which factors besides income can be used to mitigate barriers to access. This was the focus of our study on Portugal's case in the wake of the crisis. We used 17,698 observations from the 5th National Health Survey (2014). We analyzed self-reported unmet needs for medical appointments and treatments, dental healthcare, and prescribed medications. We used a bivariate selection model, considering the fact that unmet needs could only be observed in the subsample of individuals that felt the need for healthcare. The risk of unmet needs for healthcare decreased in individuals with higher income and schooling levels and in the elderly and men. Exclusive coverage by the National Health Service increased the risk of unmet dental healthcare needs. The absence of a circle of close friends to whom one can ask for help and lack of trust in others increased the likelihood of unmet healthcare needs. Better health decreased the risk of unmet needs. While income is an important predictor of unmet needs, we found the impact of other factors such as gender, age, and education. Participation in informal groups reduced the likelihood of unmet needs. Individuals with more healthcare needs end up suffering additional risk.
Collapse
Affiliation(s)
- Micaela Antunes
- Faculdade de Economia, Universidade de Coimbra, Coimbra, Portugal.,Centre for Business and Economics Research, Universidade de Coimbra, Coimbra, Portugal
| | - Luís Moura Ramos
- Faculdade de Economia, Universidade de Coimbra, Coimbra, Portugal.,Centre for Business and Economics Research, Universidade de Coimbra, Coimbra, Portugal
| | - Óscar Lourenço
- Faculdade de Economia, Universidade de Coimbra, Coimbra, Portugal.,Centre for Business and Economics Research, Universidade de Coimbra, Coimbra, Portugal
| | - Carlota Quintal
- Faculdade de Economia, Universidade de Coimbra, Coimbra, Portugal.,Centre for Business and Economics Research, Universidade de Coimbra, Coimbra, Portugal
| |
Collapse
|
27
|
Giussani G, Enia G, Bianchi E, Mecarelli O, Beghi E, Cagnetti C, Baldinelli S, Lattanzi S, La Neve A, Tappatà M, Francavilla T, De Maria G, Sofia V, Giuliano L, Mainieri G, Fatuzzo D, Belcastro V, Elia M, D'Orsi G, Lalla A, Salmaggi A, Brigo F, Magaudda A, Pisani F, Galletta S, Pisani LR, Raffaele M, Cosenza D, Villani FS, Quintas RM, Cervellione R, Borroni S, Meletti S, Ferrarese C, Barbella G, Di Francesco J, Bogliun G, Beretta S, Galimberti CA, Cantisani TA, Cecconi M, Celani MG, Papetti R, Giorgi FS, Aguglia U, Gasparini S, Ferlazzo E, Manganotti P, Crichiutti G, Bravar G. The management of epilepsy in clinical practice: Do the needs manifested by the patients correspond to the priorities of the caring physicians? Findings from the EPINEEDS Study. Epilepsy Behav 2020; 102:106641. [PMID: 31759314 DOI: 10.1016/j.yebeh.2019.106641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/01/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to assess the priorities of patients with epilepsy and caring physicians and the correspondence between these priorities. METHODS In this multicenter cross-sectional study, patients with epilepsy attending 21 Italian epilepsy centers and their caring physicians filled anonymously questionnaires on the needs and priorities in the management of the disease. Included were questions on patients' demographics, diagnosis, treatment, and outcome of epilepsy. The concordance between patients and their physicians was assessed on various aspects of the diagnosis and care of the disease. Patients' satisfaction with communication, services, and patient-doctor relationship was also assessed. RESULTS Included were 432 women and 355 men aged 15 to 88 years (median: 41 years). Disease duration ranged from 6 months to 75 years. A structural/metabolic etiology predominated (52.7%), followed by a (presumed) genetic etiology (33.0%). Seizure remission was present in 56.5% of cases. Comorbidities requiring chronic treatment were present in 27.5%, and comorbidities affecting self-sufficiency in 9.5%. Psychiatric comorbidity was present in 35.0%. Patients' priorities included discovery of the cause (89.1%), use of right drug (98.7%), use of a drug without chronic side effects (94.0%), and a life without restrictions (90.4%). Physicians' priorities included choice of right drug (83.5%) and use of drugs without chronic side effects (86.8%). Priorities varied with patients' age, sex, education, and occupation. Patient-doctor relationships were at least good in most cases. The information imparted was considered unsatisfactory by 21-44% of cases on seizure circumstances and complications, side effects of drugs, limitations of daily activities, and management of physiologic or pathologic conditions. Patients declared overall satisfaction, except for appointments (21.5%) and emergencies (30.8%). CONCLUSION Patients and physicians' priorities in the management of epilepsy overlap only in part. Patients are satisfied with their caring physicians and less satisfied with communication and management of routine and emergency problems.
Collapse
Affiliation(s)
- Giorgia Giussani
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Gabriele Enia
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Elisa Bianchi
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Oriano Mecarelli
- Dipartimento Neuroscienze Umane, Sapienza Università di Roma, Italy
| | - Ettore Beghi
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Kılınç S, Campbell C, Guy A, van Wersch A. Negotiating the boundaries of the medical model: Experiences of people with epilepsy. Epilepsy Behav 2020; 102:106674. [PMID: 31783319 DOI: 10.1016/j.yebeh.2019.106674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 01/09/2023]
Abstract
People with epilepsy (PWE) continually report dissatisfaction with the support they receive, particularly in regard to their psychological wellbeing. With its focus on optimal seizure control, epilepsy treatment is entrenched in the medical model of illness, despite growing evidence of the broader psychosocial impact of the condition. This study aimed to explore how PWE experience healthcare in the context of their lives. Semistructured interviews were conducted with thirty-nine adults with epilepsy from across the UK. An adapted version of interpretative phenomenological analysis (IPA) was conducted, and three superordinate themes were identified. Firstly, "negotiating the space between health and illness" identified how participants rejected the illness identity and struggled with a treatment regime, which reminded them of the longevity of their condition. Secondly, "tensions in adopting a biomedical perspective" considered how medical professionals overlooked the negative side effects medication had on participants' lives, in favor of optimal seizure control. Thirdly, "the need for broader support" highlighted the additional psychosocial support PWE require. The findings indicate the need to incorporate person-centered, psychological services within the care pathway for PWE, as well as training for health professionals to recognize the broader impact of epilepsy beyond seizure management.
Collapse
Affiliation(s)
- Stephanie Kılınç
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough TS1 3BX, UK.
| | | | - Alison Guy
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough TS1 3BX, UK
| | - Anna van Wersch
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough TS1 3BX, UK
| |
Collapse
|
29
|
Higgins A, Downes C, Varley J, Doherty CP, Begley C, Elliott N. Supporting and empowering people with epilepsy: Contribution of the Epilepsy Specialist Nurses (SENsE study). Seizure 2019; 71:42-49. [DOI: 10.1016/j.seizure.2019.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/28/2019] [Accepted: 06/08/2019] [Indexed: 11/25/2022] Open
|
30
|
Almanza-Sepulveda ML, Smith ML, Widjaja E. Influence of patient, caregiver, and family factors on unmet healthcare needs in children with drug-resistant epilepsy undergoing epilepsy surgery evaluation. Epilepsy Behav 2019; 99:106502. [PMID: 31493734 DOI: 10.1016/j.yebeh.2019.106502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/03/2019] [Accepted: 08/14/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether patient, caregiver, and family factors correlate with unmet healthcare needs in children with drug-resistant epilepsy (DRE) who were evaluated for epilepsy surgery. METHODS Caregivers of children with DRE completed questions on unmet healthcare needs, including physical and mental needs. Patient (demographic, seizure severity, and comorbidities), caregiver (sociodemographics, depression, and anxiety), and family (family functioning, resources, and demands) factors were evaluated. A series of bivariable regression was conducted to assess the associations with unmet needs (overall, physical, and mental needs), followed by multivariable regression. RESULTS Of the 86 children with DRE, 32 (37.2%) reported having overall unmet healthcare needs, 21 (24.4%) have unmet physical, and 13 (15.1%) have unmet mental healthcare needs. Multivariable regression showed that the odds of overall unmet needs in children were higher in patients with higher depressive symptoms (odds ratio [OR] = 1.7, p = 0.03), and caregivers who were unemployed (OR = 3.8, p = 0.008). The odds of unmet physical needs in children were higher among patients with higher depressive symptoms (OR = 2.0, p = 0.02), caregivers who were older (OR = 1.1, p = 0.02), and caregivers who were unemployed (OR = 6.5, p = 0.008). There were no significant correlates between patient, caregiver, and family factors with unmet mental needs (all p > 0.05). INTERPRETATION Children with DRE were at risk for not receiving needed healthcare. Patient factors such as patient depressive symptoms, and caregiver factors such as caregivers' age and employment status were associated with unmet needs. Identifying the predictors of unmet healthcare needs is a necessary step in addressing unmet needs in this population with DRE.
Collapse
Affiliation(s)
| | - Mary Lou Smith
- Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Canada; Department of Psychology, University of Toronto Mississauga, Toronto, Canada
| | - Elysa Widjaja
- Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Canada; Department of Diagnostic Imaging, University of Toronto, Toronto, Canada; Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada; Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
| |
Collapse
|
31
|
Munger Clary HM, Salpekar JA. Should adult neurologists play a role in the management of the most common psychiatric comorbidities? Practical considerations. Epilepsy Behav 2019; 98:309-313. [PMID: 30471892 PMCID: PMC6614011 DOI: 10.1016/j.yebeh.2018.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/10/2018] [Accepted: 10/13/2018] [Indexed: 11/17/2022]
Abstract
Despite the high prevalence and negative impact of psychiatric comorbidities on the life of adults with epilepsy, significant unmet mental health care need exists because of a variety of factors, including poor access to mental health care providers. A potential solution to address access barriers is neurologist-driven diagnosis and management of common psychiatric conditions in epilepsy, of which mood and anxiety disorders are the most common. In this manuscript, patient selection criteria and practical treatment strategies are outlined for common mood and anxiety disorders that can be safely managed by neurologists. This article is part of the Special Issue "Obstacles of Treatment of Psychiatric Comorbidities in Epilepsy".
Collapse
Affiliation(s)
- Heidi M Munger Clary
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America.
| | - Jay A Salpekar
- Departments of Psychiatry and Neurology, Johns Hopkins University, Baltimore, MD, United States of America
| |
Collapse
|
32
|
Qin S, Ding Y. Why not see a doctor when ill? Evidence from the Chinese elderly. BMC Health Serv Res 2019; 19:365. [PMID: 31182079 PMCID: PMC6558788 DOI: 10.1186/s12913-019-4212-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/31/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Elder people aged ≥45 years often have more healthcare needs than the younger. But the Chinese elderly are less likely to see a doctor when ill. In this article, this phenomenon is abbreviated as "not see a doctor". This study aimed to describe the reason distribution of"not see a doctor" among the Chinese elderly. Specifically,we examined the reasons why"not see a doctor" happened to the Chinese elderly with different characteristics. METHODS In order to explore the associations between various predisposing, enabling and need factors and "not see a doctor" in China, this cross-sectional study used the data from the 2015 wave 4 of the China Health and Retirement Longitudinal Study (CHARLS). Using multivariate analyses, associations between "not see a doctor" and factors were accessed. Models were estimated using a binary model with negative log-log link function (cases versus controls) and multinomial logit analysis (reasons for "not see a doctor"). RESULTS Adjusted by individual weight, the analysis included 16,277 people aged ≥45 years, of whom 11% reported "not see a doctor". Overall, those with older age, other marital status (except married) and poorer health status were more likely to report "not see a doctor". No significant associations were found between income and "not see a doctor". The majority of cases report "no need" as the reason for their "not see a doctor". Except reason "no need", factor associated with the healthcare system-cost-accounted for the most case of "not see a doctor". Those without health insurance are more likely not to see a doctor due to affordability issues. CONCLUSIONS This quantitative study suggests that "not see a doctor" is more likely to happen due to age and marital status issues, especially affordability issues. For China, it is important to enforce the policy of reducing of healthcare fees and increasing health insurance coverage.
Collapse
Affiliation(s)
- Shangren Qin
- Hangzhou Normal University, 2318 Yuhangtang Road, Hangzhou, 311121 China
| | - Ye Ding
- Department of Public Health, Hangzhou Medical College, 481 Binwen Road, Hangzhou, 310053 China
| |
Collapse
|
33
|
Dolo H, Mandro M, Wonya'Rossi D, Ngave F, Fraeyman J, Siewe JN, Suykerbuyk P, Colebunders R. Community perceptions of epilepsy and its treatment in an onchocerciasis endemic region in Ituri, Democratic Republic of Congo. Infect Dis Poverty 2018; 7:115. [PMID: 30509330 PMCID: PMC6278164 DOI: 10.1186/s40249-018-0498-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/24/2018] [Indexed: 01/22/2023] Open
Abstract
Background A recent study in the Logo and Rethy health zones in the Ituri Province in the Democratic Republic of Congo (DRC) reported that the majority of the persons with epilepsy (PWE) had not been treated with anti-epileptic medication (AEM) or had stopped treatment. Prior to the implementation of an epilepsy treatment programme in these health zones, this study investigated the perceptions and experiences regarding epilepsy and its treatment amongst community leaders, PWE and/or their families, traditional healers and health professionals. Methods A total of 14 focus group discussions (FGD) and 39 semi-structured interviews (SSI) were conducted with PWE and/or their family members, community leaders, traditional healers, and health professionals in the Logo and Rethy health zones during February 2–19, 2017. Results In the two health zones, the clinical signs of convulsive epilepsy were recognized by community members. However, a variety of misconceptions about epilepsy were identified including the beliefs that epilepsy is a family-related condition, a contagious disease, is transmitted by insects, saliva or by touching a person of the same sex during seizures, or is caused by evil spirits and witchcraft. The role of traditional healers in spreading these beliefs was revealed. The study also reported sexual abuse on PWE, stigmatisation of PWE and loss of productivity of PWE and their families. Some PWE had been using AEM and traditional treatment but were not convinced about the efficacy of these treatment options. The lack of training of health providers about epilepsy care, financial barriers in obtaining AEM, and the shortage of AEM at primary health facilities were revealed. As remedies, the community requested access to a decentralized center for epilepsy treatment. They also proposed using churches and community health workers as communication channels for information about epilepsy. Conclusions Clinical signs of convulsive epilepsy were recognized by the community in the Logo and Rethy health zones but many misconceptions about epilepsy were identified. A comprehensive community-based epilepsy treatment programme with an affordable uninterrupted AEM supply needs to be established. Such a programme should address stigma, misconceptions, sexual abuse and foster the rehabilitation of PWE to alleviate poverty.
Collapse
Affiliation(s)
- Housseini Dolo
- Global Health Institute, University of Antwerp, Antwerp, Belgium. .,International Center of Excellence in Research, Faculty of Medicine and Odonto Stomatology, Bamako, Mali.
| | - Michel Mandro
- Global Health Institute, University of Antwerp, Antwerp, Belgium.,Provincial Ministry of Health, Bunia, Ituri, Democratic Republic of the Congo.,Centre de Recherche en Maladies Tropicales de l'Ituri, Hopital General de Reference de Rethy, Rethy, Democratic Republic of Congo
| | - Deogratias Wonya'Rossi
- Provincial Ministry of Health, Bunia, Ituri, Democratic Republic of the Congo.,Centre de Recherche en Maladies Tropicales de l'Ituri, Hopital General de Reference de Rethy, Rethy, Democratic Republic of Congo
| | - Francoise Ngave
- Centre de Recherche en Maladies Tropicales de l'Ituri, Hopital General de Reference de Rethy, Rethy, Democratic Republic of Congo
| | - Jessica Fraeyman
- Research Group Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Joseph N Siewe
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | | | | |
Collapse
|
34
|
Higgins A, Downes C, Varley J, Doherty CP, Begley C, Elliott N. Rising to the challenge: Epilepsy specialist nurses as leaders of service improvements and change (SENsE study). Seizure 2018; 63:40-47. [PMID: 30399460 DOI: 10.1016/j.seizure.2018.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/05/2018] [Accepted: 10/25/2018] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To report the leadership role and change activities of epilepsy specialist nurses (ESNs) in Ireland; findings from the SENsE study. METHOD A mixed methods study design was used, involving 12 epilepsy specialist nurses working in five units in Ireland, 24multidisciplinary team members working with them, and 35 people with epilepsy and their family members. Data were collected using individual and focus group interviews, observation and documentary analysis. RESULTS Five key areas in which ESNs demonstrated leading on the change agenda were identified. These included: Initiating new clinical practice developments; Building capability within the multidisciplinary team; Developing education programmes and resources for people with epilepsy, family and the public; Exerting influence through membership of committees and lobbying; and Advancing the ESN role. CONCLUSION Though the epilepsy specialist nurse role was first established in the UK in 1988, much of the literature that discusses or describes the ESN role is founded on anecdotal evidence, or focusses on their clinical expertise. Findings from this study provide empirical evidence that the ESNs were involved as key players in leading changes within the services, in the education of others, and the continuous advancement of epilepsy care.
Collapse
Affiliation(s)
- Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Jarleth Varley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Colin P Doherty
- Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland.
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Naomi Elliott
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| |
Collapse
|
35
|
Patients with epilepsy care experiences: Comparison between services with and without an epilepsy specialist nurse. Epilepsy Behav 2018; 85:85-94. [PMID: 29920427 DOI: 10.1016/j.yebeh.2018.05.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 11/21/2022]
Abstract
The aim of this study was to determine whether there were differences in experiences of care, satisfaction with care and quality of life between those who were in receipt of care from a service with an epilepsy specialist nurse (ESN) and those who were receiving care from a service that did not include an ESN. A comparative design was used, which involved the completion of a confidential, self-completed survey. The survey was administered to a nonprobability convenience sample of patients with epilepsy who were attending services with an ESN (n = 244) and services where the treatment team did not include an ESN (n = 261) from each of the four health areas in Ireland. This study found that, in comparison to people with epilepsy (PWE) who attended a service without an ESN, PWE who attended a service with an ESN reported receiving greater amount of information, were more involved in their care, perceived care to be better coordinated, and had greater confidence in the information provided and greater comfort in discussing issues with an ESN. They also reported higher rates of satisfaction with the emotional and practical support offered. Thus, it may be concluded that models of care involving the input of ESNs enhance the quality of epilepsy care and care processes. The findings also emphasize the need to have an ESN as part of the multidisciplinary team.
Collapse
|
36
|
Michaelis R, Niedermann C, Reuber M, Kuthe M, Berger B. "Seizures have become a means of somehow learning things about myself" - A qualitative study of the development of self-efficacy and mastery during a psychotherapeutic intervention for people with epilepsy. Epilepsy Behav 2018; 84:152-161. [PMID: 29803945 DOI: 10.1016/j.yebeh.2018.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/17/2018] [Accepted: 04/29/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Psychological interventions may enhance health-related quality of life in people with epilepsy. The concepts of self-efficacy and mastery may be particularly relevant in the context of epilepsy. To date, the investigation of psychological interventions has not included a qualitative analysis of the effects of such interventions on the interrelation between mastery and general and epilepsy-specific self-efficacy. This qualitative study aimed to explore the relationship between the lived experiences of these concepts in people with epilepsy who participated in a resource-oriented and mindfulness-based psychotherapeutic intervention delivered on a one-to-one basis in an outpatient setting. METHODS Semi-structured pre- and postintervention interviews were conducted with people with epilepsy who participated in a six-month resource-oriented and mindfulness-based intervention. The formulation of intervention goals was based on the preintervention interviews. The intervention involved regular one-to-one interactions with the therapist, journal-keeping, and mindfulness-based relaxation. Qualitative content analysis of pre- and posttherapy interviews was conducted to characterize changes in subjective experiences. RESULTS Nine people with epilepsy aged 18-59 years participated in 9 to 22 (median 13) sessions. The following six main themes emerged: (A) Encouragement of individual solutions, (B) Awareness of the link of personal traits with seizure-related worries, (C) How to develop self-efficacy, (D) Shaping everyday life in a way that is good for oneself (general self-efficacy), (E) Coping with seizures (seizure-related self-efficacy), (F) Epilepsy as a means of increasing self-knowledge and control over one's life (sense of mastery). The patients' development of self-efficacy was motivated by their personal initial goals and facilitated by the encouragement to find individual solutions and an increased awareness of the link of personal traits with seizure-related worries. A sense of mastery only emerged through the development of general self-efficacy and as a result of the active self-examination prompted by the challenge of living with epilepsy. CONCLUSION The qualitative differences observed before and after a psychotherapeutic intervention for individuals with epilepsy increase our understanding of the complex process of psychotherapy-associated change involving self-efficacy and mastery and highlight the contribution that qualitative research approaches can make.
Collapse
Affiliation(s)
- Rosa Michaelis
- Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany; Integrated Curriculum for Anthroposophic Medicine (ICURAM), University Witten/Herdecke, Herdecke, Germany; Department of Neurology, Christian-Doppler-Clinic, Salzburg, Austria.
| | - Christina Niedermann
- Department of Psychology and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Martin Kuthe
- Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany; Medizinisches Versorgungszentrum, Evangelische Stiftung Volmarstein, Witten, Germany
| | - Bettina Berger
- Forschungs- und Lehrzentrum (FLZ) Herdecke, University Witten/Herdecke, Herdecke, Germany
| |
Collapse
|
37
|
Thurman DJ, Begley CE, Carpio A, Helmers S, Hesdorffer DC, Mu J, Touré K, Parko KL, Newton CR. The primary prevention of epilepsy: A report of the Prevention Task Force of the International League Against Epilepsy. Epilepsia 2018; 59:905-914. [PMID: 29637551 PMCID: PMC7004820 DOI: 10.1111/epi.14068] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 02/05/2023]
Abstract
Among the causes of epilepsy are several that are currently preventable. In this review, we summarize the public health burden of epilepsy arising from such causes and suggest priorities for primary epilepsy prevention. We conducted a systematic review of published epidemiologic studies of epilepsy of 4 preventable etiologic categories-perinatal insults, traumatic brain injury (TBI), central nervous system (CNS) infection, and stroke. Applying consistent criteria, we assessed the quality of each study and extracted data on measures of risk from those with adequate quality ratings, summarizing findings across studies as medians and interquartile ranges. Among higher-quality population-based studies, the median prevalence of active epilepsy across all ages was 11.1 per 1000 population in lower- and middle-income countries (LMIC) and 7.0 per 1000 in high-income countries (HIC). Perinatal brain insults were the largest attributable fraction of preventable etiologies in children, with median estimated fractions of 17% in LMIC and 15% in HIC. Stroke was the most common preventable etiology among older adults with epilepsy, both in LMIC and in HIC, accounting for half or more of all new onset cases. TBI was the attributed cause in nearly 5% of epilepsy cases in HIC and LMIC. CNS infections were a more common attributed cause in LMIC, accounting for about 5% of all epilepsy cases. Among some rural LMIC communities, the median proportion of epilepsy cases attributable to endemic neurocysticercosis was 34%. A large proportion of the overall public health burden of epilepsy is attributable to preventable causes. The attributable fraction for perinatal causes, infections, TBI, and stroke in sum reaches nearly 25% in both LMIC and HIC. Public health interventions addressing maternal and child health care, immunizations, public sanitation, brain injury prevention, and stroke prevention have the potential to significantly reduce the burden of epilepsy.
Collapse
Affiliation(s)
- David J. Thurman
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Charles E. Begley
- Health Science Center at Houston School of Public Health, University of Texas, Houston, TX, USA
| | - Arturo Carpio
- Faculty of Medical Sciences, University of Cuenca, Cuenca, Ecuador
| | - Sandra Helmers
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Dale C. Hesdorffer
- Gertrude H. Sergievsky Center and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Jie Mu
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Kamadore Touré
- Department of Neurology, Fann University Hospital, Dakar, Senegal
| | - Karen L. Parko
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Charles R. Newton
- Kenya Medical Research Institute–Wellcome Trust Collaborative Program, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
38
|
Buntinx WHE, Tan IY, Aldenkamp AP. Support values through the eyes of the patient: An exploratory study into long-term support of persons with refractory epilepsy. Epilepsy Behav 2018; 82:155-163. [PMID: 29625367 DOI: 10.1016/j.yebeh.2018.02.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/05/2018] [Accepted: 02/11/2018] [Indexed: 10/17/2022]
Abstract
A significant group of persons affected by refractory epilepsy require a wide range of long-term support from professionals as well as informal support givers. To enhance person-centeredness, it is important to know which patient values are associated with long-term support. An Internet survey produced a total of 1176 statements from 289 persons with epilepsy for analysis. Statements were expressed in the respondent's own words and were related to positive experiences (704) as well as possible areas of improvement (472) regarding the support received in the past six months. Thematic summaries of the survey results were presented to four focus groups of persons with epilepsy and proxies with a request to formulate the most important patient values which should be observed in long-term support. In iterative sessions with a panel of epilepsy experts, a framework of twelve value domains was formulated, organized in four major value clusters. An example of how these value domains can be operationalized for use in practice is next presented as a checklist to help evaluate the support patients with long-term support needs actually receive. Correspondingly, two sets of reflective questions were formulated for informal and professional support givers for the purpose of evaluating and improving person-centeredness in their support practices.
Collapse
Affiliation(s)
- Wil H E Buntinx
- Governor Kremers Center, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - In Yu Tan
- Epilepsy Center Kempenhaeghe, Heeze, The Netherlands
| | - Albert P Aldenkamp
- Epilepsy Center Kempenhaeghe, Heeze, The Netherlands; Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|