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Quinn KG, Hunt B, Jacobs J, Valencia J, Hirschtick J, Walsh JL. Community Cohesion, Social Support, and Mental Health among Black Individuals in Chicago: A Cross-Sectional Examination of the Effects on COVID-19 Vaccination. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01837-6. [PMID: 37872464 DOI: 10.1007/s40615-023-01837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
The COVID-19 pandemic put a significant strain on communities, social resources, and personal relationships, disproportionately impacting Black and low-income communities in the United States. Community cohesion and social support are positively associated with numerous health outcomes and preventive health measures, yet were strained during the pandemic due to COVID mitigation measures. This study examined the relationships between social cohesion, social support, mental health, and COVID-19 vaccination to understand whether community cohesion and social support were associated with increased likelihood of receiving a COVID-19 vaccination. Data are from a cross-sectional survey of 537 Black Chicagoans that was disseminated between September 2021 and March 2022. Structural equation modeling was used to test associations between community cohesion, social support, loneliness, anxiety, stress, and having received a COVID-19 vaccination. Results demonstrated that social support mediated associations between community cohesion and loneliness, anxiety, and stress, but was not associated with COVID-19 vaccination. These results demonstrate the importance of community cohesion and social support on mental health and suggest there are other potential pathways that may link community cohesion and vaccination.
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Affiliation(s)
- Katherine G Quinn
- Medical College of Wisconsin, Center for AIDS Intervention Research, Milwaukee, WI, 53202, USA.
| | - Bijou Hunt
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jacquelyn Jacobs
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jesus Valencia
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | | | - Jennifer L Walsh
- Medical College of Wisconsin, Center for AIDS Intervention Research, Milwaukee, WI, 53202, USA
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Wong SC, Do PH, Eisner M, Hughes C, Valdebenito S, Murray AL. An Umbrella Review of the Literature on Perinatal Domestic Violence: Prevalence, Risk Factors, Possible Outcomes and Interventions. TRAUMA, VIOLENCE & ABUSE 2023; 24:1712-1726. [PMID: 35343325 DOI: 10.1177/15248380221080455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Perinatal domestic violence (P-DV) is a common form of violence experienced by women and is associated with adverse impacts on their own physical and mental health and that of their offspring. Illuminating the risk factors for, potential effects of, and promising interventions to reduce P-DV is essential for informing policies to tackle P-DV and mitigate its negative impacts. This umbrella review of recent high-quality systematic reviews and meta-analyses of worldwide research on P-DV provides a systematic synthesis of current knowledge relating to the prevalence, risk factors for, possible outcomes of and interventions to reduce and prevent P-DV. 13 reviews identified through systematic searches of computerised databases, manual search and expert consultation met our inclusion criteria (i.e. English systematic reviews and/or meta-analyses that were from recent 10 years, focused on women exposed to P-DV, assessed risk factors, possible outcomes and/or interventions, and were of fair to high methodological quality). Our results suggest that while there is a growing understanding of risk factors and possible outcomes of P-DV, this knowledge has thus far not been translated well into effective interventions. P-DV intervention programmes that have been subject to rigorous evaluation are mostly relatively narrow in scope and could benefit from targeting a wider range of maternal and child wellbeing outcomes, and perpetrator, relationship and community risk factors. The overall quality of the evidence syntheses in this field is reasonable; however, future studies should involve multiple reviewers at all key stages of systematic reviews and meta-analyses to help enhance reliability.
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Affiliation(s)
- Siu-Ching Wong
- Department of Psychology, University of Edinburgh
- Centre for Family Research, University of Cambridge
| | - Phuc Huyen Do
- School of Public Health and Social Work, Queensland University of Technology
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Nair PMK, Silwal K, Arankale D, Sharma H, Tewani GR. Unity of Disease and Unity of Cure: An Evidence-based Perspective. Integr Med (Encinitas) 2023; 22:38-43. [PMID: 37534022 PMCID: PMC10393381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Context One of the governing principles of naturopathic medicine is the concept of Unity of Disease and Unity of Cure (UDUC). Many naturopathic physicians and students find it challenging to provide a scientific basis for UDUC because conventionally every disease has varying etiologies. Objective The review intended to explore the basis of UDUC, examining the available theoretical evidence around this fundamental tenet of naturopathic medicine, to promote its effective use when consulting new patients and planning the subsequent treatment. Design The research team performed a narrative review by searching PubMed, PubMed central, Scopus, Google scholar databases, textbooks on naturopathy and websites of professional bodies representing naturopathic medicine. The search used the keywords 'Naturopathic Medicine', 'Naturopathy', 'Holism', 'Self-healing', 'Pyschosocial determinants and health', 'unity of disease and unity of cure', 'health and disease', 'Multi-model approach', 'whole-system practice' and 'Global naturopathic practice'. Setting The review took place at Sant Hirdaram Medical College of Naturopathy and Yogic Sciences for women in Bhopal, Madhya Pradesh, India. Results The present review provides a comprehensive overview of the scientific evidence behind UDUC under four layers: psychological factors, lifestyle factors, physiological alterations, and disease manifestation. The data presented in this review substantiate the presence of these four layers in the manifestation of various clinical conditions like musculoskeletal disorders, obstetric and gynecological disorders, cardiometabolic disorders, infectious disorders, and gastrointestinal disorders. Conclusions It's very evident that the global naturopathic profession embraces traditional philosophies as the core of their practices. However, the field needs measures, such as the formulation of international working groups and the organization of continuous medical-education programs, congresses, and exchange programs, to facilitate crosstalk among practitioners from different parts of the world, which may assert the importance of philosophical tenets such as UDUC in clinical practice.
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Affiliation(s)
| | | | - Dhananjay Arankale
- General Secretary, Indian Naturopathy and Yoga Graduates’ Medical Association, Maharashtra Chapter, Pune, Maharashtra, India
| | - Hemanshu Sharma
- Principal and Head, Community Medicine, Sant Hirdaram Medical College of Naturopathy and Yogic Sciences, Bhopal, Madhya Pradesh, India
| | - Gulab Rai Tewani
- Chief Medical Officer, Sant Hirdaram Yoga and Nature Cure Hospital, Bhopal, Madhya Pradesh, India
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Zhang Y, Liu N, Li Y, Long Y, Baumgartner J, Adamkiewicz G, Bhalla K, Rodriguez J, Gemmell E. Neighborhood infrastructure-related risk factors and non-communicable diseases: a systematic meta-review. Environ Health 2023; 22:2. [PMID: 36604680 PMCID: PMC9814186 DOI: 10.1186/s12940-022-00955-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/29/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND With rapid urbanization, the urban environment, especially the neighborhood environment, has received increasing global attention. However, a comprehensive overview of the association between neighborhood risk factors and human health remains unclear due to the large number of neighborhood risk factor-human health outcome pairs. METHOD On the basis of a whole year of panel discussions, we first obtained a list of 5 neighborhood domains, containing 33 uniformly defined neighborhood risk factors. We only focused on neighborhood infrastructure-related risk factors with the potential for spatial interventions through urban design tools. Subsequently, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic meta-review of 17 infrastructure-related risk factors of the 33 neighborhood risk factors (e.g., green and blue spaces, proximity to major roads, and proximity to landfills) was conducted using four databases, Web of Science, PubMed, OVID, and Cochrane Library, from January 2000 to May 2021, and corresponding evidence for non-communicable diseases (NCDs) was synthesized. The review quality was assessed according to the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) standard. RESULTS Thirty-three moderate-and high-quality reviews were included in the analysis. Thirteen major NCD outcomes were found to be associated with neighborhood infrastructure-related risk factors. Green and blue spaces or walkability had protective effects on human health. In contrast, proximity to major roads, industry, and landfills posed serious threats to human health. Inconsistent results were obtained for four neighborhood risk factors: facilities for physical and leisure activities, accessibility to infrastructure providing unhealthy food, proximity to industry, and proximity to major roads. CONCLUSIONS This meta-review presents a comprehensive overview of the effects of neighborhood infrastructure-related risk factors on NCDs. Findings on the risk factors with strong evidence can help improve healthy city guidelines and promote urban sustainability. In addition, the unknown or uncertain association between many neighborhood risk factors and certain types of NCDs requires further research.
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Affiliation(s)
- Yuyang Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Ningrui Liu
- School of Architecture, Tsinghua University, Beijing, China
| | - Yan Li
- School of Architecture, Tsinghua University, Beijing, China
| | - Ying Long
- School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of Education, Tsinghua University, No. 1 Qinghuayuan, Haidian District, Beijing, 100084, China.
| | - Jill Baumgartner
- Institute for Health and Social Policy & Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan, School of Public Health, Boston, MA, USA
| | - Kavi Bhalla
- Public Health Sciences, University of Chicago, Chicago, IL, USA
| | | | - Emily Gemmell
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Fien S, Linton C, Mitchell JS, Wadsworth DP, Szabo H, Askew CD, Schaumberg MA. Characteristics of community-based exercise programs for community-dwelling older adults in rural/regional areas: a scoping review. Aging Clin Exp Res 2022; 34:1511-1528. [PMID: 35152393 PMCID: PMC8852913 DOI: 10.1007/s40520-022-02079-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/17/2022] [Indexed: 12/02/2022]
Abstract
Community-based exercise programs for older adults play a potentially important role in mitigating the decline in functional outcomes, body composition, psychosocial outcomes, and cardiovascular health outcomes that commonly occurs with advancing age. There is a limited understanding of the characteristics and effectiveness of community-based exercise programs, particularly when those programs are offered outside metropolitan areas. Rural/regional settings face unique challenges, such as limited access to equipment/resources, transportation, and services, as well as significant costs to run programs. The objective of this scoping review was to characterise studies in the field that have aimed to implement community-based programs in settings identified as rural / regional. A secondary aim was to establish guidance for future exercise programs in this setting and highlight future research directions. A total of 12 studies were conducted in settings identified as rural/regional areas in various countries across the world were included. Of the included studies, five were randomised controlled trials. The majority of included studies reported on functional outcomes (83%) and psychosocial outcomes (75%), yet only 42% reported body composition, 17% reported cardiovascular health and 17% reported dietary outcomes. Low male representation was observed, with women outnumbering men in 7 of 12 studies. There was also minimal investigation of qualitative outcomes in existing community-based exercise programs in rural/regional settings, presenting a key gap for future research to address. Study Protocol: https://osf.io/txpm3/ . Date of registration: 20 July 2020.
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Affiliation(s)
- Samantha Fien
- School of Health, Medical and Applied Sciences, Central Queensland University, Mackay, Australia.
| | - Corey Linton
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Jules S Mitchell
- Thompson Institute, University of the Sunshine Coast, Birtinya, Australia
| | - Daniel P Wadsworth
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | | | - Christopher D Askew
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - Mia A Schaumberg
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
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Ma X, Biaggi A, Sacchi C, Lawrence AJ, Chen PJ, Pollard R, Matter M, Mackes N, Hazelgrove K, Morgan C, Harding S, Simonelli A, Schumann G, Pariante CM, Mehta M, Montana G, Rodriguez-Mateos A, Nosarti C, Dazzan P. Mediators and moderators in the relationship between maternal childhood adversity and children's emotional and behavioural development: a systematic review and meta-analysis. Psychol Med 2022; 52:1817-1837. [PMID: 35730541 PMCID: PMC9340854 DOI: 10.1017/s0033291722001775] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/06/2022]
Abstract
Maternal experiences of childhood adversity can increase the risk of emotional and behavioural problems in their children. This systematic review and meta-analysis provide the first narrative and quantitative synthesis of the mediators and moderators involved in the link between maternal childhood adversity and children's emotional and behavioural development. We searched EMBASE, PsycINFO, Medline, Cochrane Library, grey literature and reference lists. Studies published up to February 2021 were included if they explored mediators or moderators between maternal childhood adversity and their children's emotional and behavioural development. Data were synthesised narratively and quantitatively by meta-analytic approaches. The search yielded 781 articles, with 74 full-text articles reviewed, and 41 studies meeting inclusion criteria. Maternal mental health was a significant individual-level mediator, while child traumatic experiences and insecure maternal-child attachment were consistent family-level mediators. However, the evidence for community-level mediators was limited. A meta-analysis of nine single-mediating analyses from five studies indicated three mediating pathways: maternal depression, negative parenting practices and maternal insecure attachment, with pooled indirect standardised effects of 0.10 [95% CI (0.03-0.17)), 0.01 (95% CI (-0.02 to 0.04)] and 0.07 [95% CI (0.01-0.12)], respectively. Research studies on moderators were few and identified some individual-level factors, such as child sex (e.g. the mediating role of parenting practices being only significant in girls), biological factors (e.g. maternal cortisol level) and genetic factors (e.g. child's serotonin-transporter genotype). In conclusion, maternal depression and maternal insecure attachment are two established mediating pathways that can explain the link between maternal childhood adversity and their children's emotional and behavioural development and offer opportunities for intervention.
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Affiliation(s)
- Xuemei Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Alessandra Biaggi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Chiara Sacchi
- Department of Developmental Psychology and Socialisation, University of Padova, Padua, Italy
| | - Andrew J. Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Pei-Jung Chen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Rebecca Pollard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Maryam Matter
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Nuria Mackes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Craig Morgan
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Seeromanie Harding
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialisation, University of Padova, Padua, Italy
| | - Gunter Schumann
- Biological Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carmine M. Pariante
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Biological Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mitul Mehta
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Neuroimaging & Psychopharmacology, Centre of Neuroimaging Sciences, King's College London, London, UK
| | | | - Ana Rodriguez-Mateos
- Department of Nutritional Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Chiara Nosarti
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Centre for the Developing Brain, Department of Perinatal Imaging & Health, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Department of Developmental Psychology and Socialisation, University of Padova, Padua, Italy
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Citizen science in the community: Gaining insight in community and participant health in four deprived neighbourhoods in the Netherlands. Health Place 2022; 75:102798. [PMID: 35364470 DOI: 10.1016/j.healthplace.2022.102798] [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: 02/08/2021] [Revised: 02/14/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022]
Abstract
The aim of this study was to examine if citizen science contributes to gaining insight into community health and to the health of the citizen scientists themselves. Therefore, thirteen citizens in four deprived neighbourhoods were trained as citizen scientists to conduct research in their own communities. Results showed that the citizen scientists identified forty (health related) themes in their communities. The citizen scientists reported an increase in their overall self-perceived health which, however, was not significantly demonstrated in the prequestionnaire and postquestionnaire.
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Saar M, Nase M. Psycho-social wellbeing in migration studies—the potential of the concept of actionability. MIGRATION STUDIES 2022. [DOI: 10.1093/migration/mnab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Psycho-social wellbeing has been difficult to define for social sciences as it stands now. In migration research, studies usually rely on belonging, social interactions, or structural problems which migrants encounter upon arrival. All these approaches provide relevant insights, but struggle to address the more individual and psycho-social aspects of the migration process and subsequent adaptation period. This article proposes to shift the focus away from the internal world of the migrant, which is challenging for most social sciences to measure, and instead consider their outward actions. To this end, we introduce the concept of actionability, a term which is to be understood as an individual’s ability to formulate and execute long-term plans based on their perceived needs, desires, and concerns. The idea of actionability allows us to assess how migrants interact with their environment and can formulate and successfully execute plans. By using 37 interviews with highly skilled Estonian migrants in UK, the article suggests that actionability is tightly connected to reflexive modes, developed by Archer, and that certain reflexive types have predictable patterns in how they react to the migration experience.
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Affiliation(s)
- Maarja Saar
- Department of Sociology, Södertörn University, Stockholm, Sweden
| | - Marco Nase
- Department of History, Södertörn University, Stockholm, Sweden
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9
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Peter KA, Helfer T, Golz C, Halfens RJG, Hahn S. Development of an Interrelated Definition of Psychosocial Health for the Health Sciences Using Concept Analysis. J Psychosoc Nurs Ment Health Serv 2021; 60:19-26. [PMID: 34932421 DOI: 10.3928/02793695-20211214-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The term psychosocial health encompasses a variety of definitions and references among different disciplines, and it is widely used in various settings within the health professions and health sciences; however, the term is difficult to conceptualize, which has led to its random and unspecified usage. To bring clarity to use of this term, a concept analysis was conducted. After a careful selection process, 15 articles, including those with their primary published definition, were analyzed and synthesized. The central attributes of the concept of psychosocial health were identified, and an overarching definition addressing its various aspects was proposed. The resulting definition is comprehensive and applicable to a variety of disciplines within the health professions. The definition provides a new understanding and increased clarity for this complex term. Importantly, it will also assist in promoting the psychosocial health of patients as well as health professionals. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
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Harner V, Munion AK, Shelton J. Trans Adults Amidst the COVID-19 Pandemic: Quality of Life, Pandemic Impact, and Vaccine Preferences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12536. [PMID: 34886263 PMCID: PMC8657091 DOI: 10.3390/ijerph182312536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 02/03/2023]
Abstract
The ongoing COVID-19 pandemic is disproportionately impacting marginalized communities, such as Black, Indigenous, and people of color (BIPOC), disabled individuals, and transgender/nonbinary (i.e., trans) individuals. As trans individuals may be multiply marginalized, it is necessary to examine within group differences among trans individuals of different genders, races, socioeconomic statuses, and abilities. This study examines the following research questions: (1) What is the quality of life of trans adults during the COVID-19 pandemic? (2) How does the self-reported impact of the pandemic vary across groups within the trans community? (3) What preferences do trans adults have regarding receiving a COVID-19 vaccine? Survey data were collected in August/September of 2020. Among a sample of 449 trans adults, findings suggest that the profound impact of the pandemic was not consistent across all community members. Being a woman predicted a higher self-reported impact of the pandemic while being a masc(uline) white respondent tended to predict a lower impact of the pandemic. Higher income was associated with a higher quality of life and being a disabled white respondent predicted a lower quality of life. The majority (99%) of the sample reported wanting to receive a COVID-19 vaccine should one become available. Implications for practice include the importance of considering the holistic experiences of clients and community members, as opposed to having homogenized perspectives of even subsets of the trans community. Future research related to barriers faced when attempting to access a vaccine is needed to inform future public health responses to epidemics/pandemics impacting this community.
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Affiliation(s)
- Vern Harner
- School of Social Work, University of Washington, Seattle, WA 98105, USA
| | - Ascher K. Munion
- Department of Psychology, East Carolina University, Greenville, NC 27858, USA;
| | - Jama Shelton
- Silberman School of Social Work, City University of New York, New York, NY 10065, USA;
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11
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Roesch PT, Velonis AJ, Sant SM, Habermann LE, Hirschtick JL. Implications of Interpersonal Violence on Population Mental Health Status in a Low-Income Urban Community-Based Sample of Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:8891-8914. [PMID: 31319734 DOI: 10.1177/0886260519862365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research links interpersonal violence (IPV) perpetrated by a close personal contact, such as a family member or partner, to poor mental health; however, few studies assess associations by gender and explore the community-wide impacts of IPV on rates of depression and posttraumatic stress disorder (PTSD). Using Sinai Community Health Survey (2015-2016), a face-to-face probability survey in 10 Chicago neighborhoods, we examined the association of a broad IPV measure, ever being emotionally or physically abused by a partner or someone important to you, with current depressive (DEPsym) or PTSD symptoms (PTSDsym), stratified by gender. After logistic regression model building, we used direct model-based standardization to calculate adjusted relative prevalence and population attributable prevalence fractions. Of 1,535 respondents, 8% of men and 15% of women had DEPsym; 15% and 20% had PTSDsym, respectively; and 12% and 26% ever experienced IPV, respectively. Controlling for confounders, men who experienced IPV had a 3.6 times (95% confidence interval [CI]: [1.5, 6.8]) higher prevalence of DEPsym and a 2.5 times (95% CI: [1.3, 4.9]) higher prevalence of PTSDsym. Women who experienced IPV had a 2.2 times (95% CI: [1.1, 3.9]) higher prevalence of DEPsym. If the association between IPV and mental health is causal, almost one in three cases of DEPsym (males: 31.7%; females: 27.3%) and one in five cases of PTSDsym (19.2%) among males may be attributed to IPV. Our findings underscore the need for a public health response to IPV and mental health, and additional research on evidence-driven practices that address this association among men and women.
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12
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Santini ZI, Becher H, Jørgensen MB, Davidsen M, Nielsen L, Hinrichsen C, Madsen KR, Meilstrup C, Koyanagi A, Stewart-Brown S, McDaid D, Koushede V. Economics of mental well-being: a prospective study estimating associated health care costs and sickness benefit transfers in Denmark. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1053-1065. [PMID: 33861391 PMCID: PMC8318969 DOI: 10.1007/s10198-021-01305-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/27/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Previous literature has examined the societal costs of mental illness, but few studies have estimated the costs associated with mental well-being. In this study, a prospective analysis was conducted on Danish data to determine 1) the association between mental well-being (measured in 2016) and government expenditure in 2017, specifially healthcare costs and sickness benefit transfers. METHODS Data stem from a Danish population-based survey of 3,508 adults (aged 16 + years) in 2016, which was linked to Danish registry data. A validated scale (WEMWBS) was used for the assessment of mental well-being. Costs are expressed in USD PPP. A two-part model was applied to predict costs in 2017, adjusting for sociodemographics, health status (including psychiatric morbidity and health behaviour), as well as costs in the previous year (2016). RESULTS Each point increase in mental well-being (measured in 2016) was associated with lower healthcare costs ($- 42.5, 95% CI = $- 78.7, $- 6.3) and lower costs in terms of sickness benefit transfers ($- 23.1, 95% CI = $- 41.9, $- 4.3) per person in 2017. CONCLUSIONS Estimated reductions in costs related to mental well-being add to what is already known about potential savings related to the prevention of mental illness. It does so by illustrating the savings that could be made by moving from lower to higher levels of mental well-being both within and beyond the clinical range. Our estimates pertain to costs associated with those health-related outcomes that were included in the study, but excluding other social and economic outcomes and benefits. They cover immediate cost estimates (costs generated the year following mental well-being measurement) and not those that could follow improved mental well-being over the longer term. They may therefore be considered conservative from a societal perspective. Population approaches to mental health promotion are necessary, not only to potentiate disease prevention strategies, but also to reduce costs related to lower levels of mental well-being in the non-mental illness population. Our results suggest that useful reductions in both health care resource use and costs, as well as in costs due to sick leave from the workplace, could be achieved from investment in mental well-being promotion within a year.
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Affiliation(s)
- Ziggi Ivan Santini
- The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.
| | - Hannah Becher
- The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Maja Bæksgaard Jørgensen
- The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Michael Davidsen
- The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Line Nielsen
- The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Carsten Hinrichsen
- The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Katrine Rich Madsen
- The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Charlotte Meilstrup
- The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Dr Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Vibeke Koushede
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark
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13
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Egan M, Abba K, Barnes A, Collins M, McGowan V, Ponsford R, Scott C, Halliday E, Whitehead M, Popay J. Building collective control and improving health through a place-based community empowerment initiative: qualitative evidence from communities seeking agency over their built environment. CRITICAL PUBLIC HEALTH 2021. [DOI: 10.1080/09581596.2020.1851654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Katherine Abba
- Division of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Amy Barnes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michelle Collins
- Department of Health Research, Lancaster University, Lancaster, UK
| | - Vicki McGowan
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Ruth Ponsford
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Courtney Scott
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma Halliday
- Department of Health Research, Lancaster University, Lancaster, UK
| | - Margaret Whitehead
- Division of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Jennie Popay
- Department of Health Research, Lancaster University, Lancaster, UK
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Apaza-Panca CM, Maquera-Luque PJ, Huanca-Frías JO, Supo-Quispe LA, Távara-Ramos AP, Dextre-Martínez WR, Saldaña-Acosta OA. Factores psicosociales en estudiantes universitarios de Loreto, Ancash, Moquegua y Puno durante el confinamiento por el Covid-19, Perú. CUESTIONES POLÍTICAS 2021. [DOI: 10.46398/cuestpol.3968.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The study was carried out with the objective of comparing and analyzing psychosocial factors such as stress, depression and anxiety in undergraduate university students from Loreto, Ancash, Moquegua and Puno during confinement by Covid-19, Peru. The study was based on a non-experimental, quantitative-descriptive, cross-sectional and correlational design with non-probability and intentional sampling, an online survey was applied to a sample of 665 undergraduate students using validated instruments such as the List of Indicators of Vulnerability to stress, the Zung Depression Scale, and the Hamilton Anxiety Scale. The study reports vulnerability to stress in 50.8%, 46.3%, 36.4% and 37.5% in Loreto, Ancash, Moquegua and Puno. The prevalence of depression was 100.0%, 97.6%, 96.9% and 95.2% between mild, moderate and severe; likewise, 100.0% presented anxiety symptoms. It was concluded that a situation of obligatory social confinement is directly related to the presence of stress, depression and anxiety, particularly in undergraduate university students, affecting a greater proportion of women; of these between 19 and 22 years, and with a higher incidence in regions with a greater number of confirmed cases; where insomnia, worry and irritability are the most significant symptoms.
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15
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Astor RA, Noguera P, Fergus E, Gadsden V, Benbenishty R. A Call for the Conceptual Integration of Opportunity Structures Within School Safety Research. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2020.1854621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Stalker KC, Brown ME, Evans CBR, Hibdon J, Telep C. Addressing Crime, Violence, and Other Determinants of Health through Community-Based Participatory Research and Implementation Science. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:392-403. [PMID: 32691885 DOI: 10.1002/ajcp.12438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this paper, we describe the assessment and planning phase of the Thrive community-based initiative to reduce violence and address other determinants of health in a community in the Southwestern United States. Using community-based participatory research (CBPR) and an implementation science framework, we engaged residents and other key stakeholders as equal partners in the assessment and planning process. The Thrive assessment and planning phase involved collaboration among researchers, residents, law enforcement, nonprofit agencies, public health, local government, and other cross-sector partners. We used implementation science in order to examine the barriers and facilitators to addressing community health and safety, to assess the nature and scope of health and safety issues, to review existing solutions, to assess the acceptability and necessary adaptations of selected interventions, and to assess feasibility and sustainability of the initiative. Through interviews, focus groups, analysis of crime incident data, geomapping, and direct observations, our findings highlighted the presence of an open-air drug market, the high-stress nature of the community, concern for the lack of opportunities for youth, the lack of trust between residents and law enforcement, and a need to address the built environment to promote safety and well-being.
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Affiliation(s)
| | | | | | - Julie Hibdon
- Southern Illinois University, Carbondale, IL, USA
| | - Cody Telep
- Arizona State University, Tucson, AZ, USA
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Levasseur M, Routhier S, Clapperton I, Doré C, Gallagher F. Social participation needs of older adults living in a rural regional county municipality: toward reducing situations of isolation and vulnerability. BMC Geriatr 2020; 20:456. [PMID: 33160305 PMCID: PMC7648429 DOI: 10.1186/s12877-020-01849-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social participation is restricted for approximately half the older adult population but is critical in fostering community vitality, promoting health, and preventing disabilities. Although targeted through interventions by community organizations, healthcare professionals and municipalities, little is known about the needs of older adults to participate socially, especially in rural areas. This study thus aimed to identify and prioritize the social participation needs of older adults living in a rural regional county municipality. METHODS A participatory action research was conducted in a rural regional county municipality (RCM) in Quebec, Canada, with a convenience sample of 139 stakeholders, including older adults, caregivers, healthcare and community organization managers, healthcare and community organization workers, community partners and key informants. RESULTS Facilitators and barriers to social participation are related to personal factors (e.g., health, interests, motivation), the social environment (e.g., availability of assistance or volunteers) and the physical environment (e.g., distance to resources, recreational facilities and social partners). Nine older adults' needs emerged and were prioritized as follows: 1) having access to and being informed about transportation options, 2) being informed about available activities and services, 3) having access to activities, including volunteering opportunities, suited to their interests, schedule, cost, language and health condition, 4) being accompanied to activities, 5) having access to meeting places near home and adapted to their health condition, and 6-9 (no preferred order) being reached when isolated, being personally invited and welcomed to activities, having a social support network, and being valued and recognized. Differences emerged when prioritizing needs of older adults with disabilities (greater need for assistance, accessibility and adapted activities) and older adults living in a rural area (greater need for transportation). CONCLUSIONS To promote active participation in the community, the social participation needs of older women and men living in rural areas must be addressed, especially in regard to transportation, information, adapted activities, assistance and accessibility. The first part of this action research will be followed by community selection and implementation of initiatives designed to ultimately foster their social participation.
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Affiliation(s)
- Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada.
- Research Centre on Aging, Estrie Integrated University Health and Social Services Centre - Sherbrooke University Hospital Center (CIUSSS de l'Estrie - CHUS), Sherbrooke, Québec, Canada.
| | - Sonia Routhier
- Research Centre on Aging, Estrie Integrated University Health and Social Services Centre - Sherbrooke University Hospital Center (CIUSSS de l'Estrie - CHUS), Sherbrooke, Québec, Canada
| | - Irma Clapperton
- Public Health Direction, CIUSSS de l'Estrie - CHUS, Sherbrooke, Québec, Canada
| | - Chantal Doré
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
- University Institute for Primary Health Care & Social Services, CIUSSS de l'Estrie - CHUS, Sherbrooke, Québec, Canada
| | - Frances Gallagher
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Centre, CIUSSS de l'Estrie - CHUS, Sherbrooke, Québec, Canada
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Kress S, Razum O, Zolitschka KA, Breckenkamp J, Sauzet O. Does social cohesion mediate neighbourhood effects on mental and physical health? Longitudinal analysis using German Socio-Economic Panel data. BMC Public Health 2020; 20:1043. [PMID: 32611338 PMCID: PMC7328265 DOI: 10.1186/s12889-020-09149-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neighbourhood has risen as a relevant determinant of health. While there is substantial evidence that environmental factors affect health, far less evidence of the role of social mechanisms in the causal chain between neighbourhood characteristics and health is available. METHOD To evaluate the role of social cohesion as a mediator between four different neighbourhood characteristics and health using data from German Socio-Economic-Panel (SOEP), a longitudinal mediation analysis was performed. Multilevel linear regression models adjusted for socio-economic variables involved three time points and two measures of physical and mental health (physical and mental component scores (PCS and MCS) of the SF12 Questionnaire. Participants were followed-up for 4 and 10 year starting in 2004. RESULTS A total of 15,518 measures of MCS and PCS on 10,013 participants living in 4985 households were included. After adjusting for values of MCS and PCS at baseline and demographic/socio-economic variables, social cohesion was a significant positive predictor of both MCS and PCS (β-coefficient MCS: 1.57 (0.27); PCS: 1.50 (0.24)). Interaction between social cohesion and follow-up were significant for PCS. The effect of environmental and built characteristics on health was consistently mediated by social cohesion with proportion varying between 10 and 23%. DISCUSSION We show that social cohesion is part of the causal chain between environmental and built characteristics of a neighbourhood and health, with increasing mediation effect over time for physical health. Social mechanisms should be considered when studying the effect of neighbourhood characteristics on health inequalities making social cohesion as a legitimate target of public health interventions at neighbourhood level.
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Affiliation(s)
- Sara Kress
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kim Alexandra Zolitschka
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jürgen Breckenkamp
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Odile Sauzet
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany. .,Centre for Statistics, Bielefeld University, Bielefeld, Germany.
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19
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From Challenges to Resources: A Qualitative Study of Cancer Coordinators' Experiences of Barriers and Facilitators to Enacting Their System-Focused Tasks. Cancer Nurs 2020; 42:345-354. [PMID: 29933310 DOI: 10.1097/ncc.0000000000000617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cancer coordinators (CCs) operate at both patient and system levels in order to provide patients with tailored and coordinated services. In common with international CCs, Norwegian CCs denote notable progress in their patient-focused work, while reporting ongoing challenges in carrying out system-focused tasks. However, little is known about the barriers and facilitators for CCs' system-level work. OBJECTIVE The aim of this study was to explore Norwegian CCs' experiences of barriers and facilitators for enacting system-focused tasks. METHODS The study applies a qualitative method, conducting an interpretative data inquiry of semistructured in-depth interviews with 26 Norwegian CCs. The data were analyzed using thematic analysis and discussed in light of previous research and salutogenic theory. RESULTS The analyses revealed 3 main themes: (1) "understanding the role and local cancer care," (2) "systems for care delivery in primary healthcare," and (3) "commitment to collaboration." Where present, the themes could represent important facilitators, whereas their absence could depict notable challenges to CCs system-focused work. Over time, as CCs were able to mobilize resources, they were able to gradually turn initial challenges into facilitators in the context of system-level work. CONCLUSIONS Cancer coordinators encounter cognitive, practical, and relational topics that impact their system-focused activities. Adopting a salutogenic focus can help CCs mobilize resources needed to turn challenges into facilitators for system-level work. IMPLICATIONS FOR PRACTICE Cancer care coordination cannot be undertaken by CCs alone. Cancer coordinators' embedding in multidisciplinary teams, common systems for care provision, meaningful work relations, and professionals' commitment to cancer care represent important facilitators for CCs' system-focused tasks.
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Pérez E, Braën C, Boyer G, Mercille G, Rehany É, Deslauriers V, Bilodeau A, Potvin L. Neighbourhood community life and health: A systematic review of reviews. Health Place 2020; 61:102238. [PMID: 31735517 DOI: 10.1016/j.healthplace.2019.102238] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/17/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022]
Abstract
Neighbourhood community life has been widely recognized as an important determinant of population health. This systematic review of reviews provides an overview of the evidence for the ecological correlation between neighbourhood community life and population health. Nine databases were searched from 2008 to 2018 in order to identify systematic reviews of studies examining the association between neighbourhood community life and population health in urban neighbourhoods within the Organisation for Economic Co-operation and Development countries. Two reviewers completed selection and data extraction, then assessed the methodological quality of reviews using the Measurement Tool to Assess Systematic Reviews. We identified three high quality reviews and five of moderate quality. The reviews vary in quality of methodology, concepts, and measures. Most of the reviews examined the influence of social cohesion, social capital, and social interactions on health. Reviews found evidence supporting a consistently favourable correlation between social cohesion and physical activity, as well as a favourable trend in the relationship between social cohesion and healthy weight. They also found evidence of a favourable trend in the correlation between social capital and healthy weight. Reviews identified studies supporting a consistently favourable correlation between social interaction and depression. We identify evidence of a positive association between neighbourhood community life and several population health outcomes. Future research should define and conceptualize neighbourhood community life factors and health indicators to improve the comparison between studies and the process of evidence synthesis. This will also enable policy makers to take appropriate decisions.
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Affiliation(s)
- Elsury Pérez
- École de santé publique de l'Université de Montréal, Canada.
| | - Caroline Braën
- École de santé publique de l'Université de Montréal, Canada
| | - Ginette Boyer
- Chaire de recherche du Canada Approches communautaires et inégalités de santé (CACIS), Canada
| | | | - Émilie Rehany
- Centre de recherche Léa-Roback sur les inégalités sociales de santé de Montréal, Canada
| | | | | | - Louise Potvin
- École de santé publique de l'Université de Montréal and Director, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), Canada
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21
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Roy B, Riley C, Herrin J, Spatz E, Hamar B, Kell KP, Rula EY, Krumholz H. Associations between community well-being and hospitalisation rates: results from a cross-sectional study within six US states. BMJ Open 2019; 9:e030017. [PMID: 31780588 PMCID: PMC6886944 DOI: 10.1136/bmjopen-2019-030017] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 10/24/2019] [Accepted: 11/07/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the association between community well-being, a positively framed, multidimensional assessment of the health and quality of life of a geographic community, and hospitalisation rates. DESIGN Cross-sectional study SETTING: Zip codes within six US states (Florida, Iowa, Nebraska, New York, Pennsylvania and Utah) MAIN OUTCOME MEASURES: Our primary outcome was age-adjusted, all-cause hospitalisation rates in 2010; secondary outcomes included potentially preventable disease-specific hospitalisation rates, including cardiovascular-related, respiratory-related and cancer-related admissions. Our main independent variable was the Gallup-Sharecare Well-Being Index (WBI) and its domains (life evaluation, emotional health, work environment, physical health, healthy behaviours and basic access). RESULTS Zip codes with the highest quintile of well-being had 223 fewer hospitalisations per 100 000 (100k) residents than zip codes with the lowest well-being. In our final model, adjusted for WBI respondent age, sex, race/ethnicity and income, and zip code number of hospital beds, primary care physician density, hospital density and admission rates for two low-variation conditions, a 1 SD increase in WBI was associated with 5 fewer admissions/100k (95% CI 4.0 to 5.8; p<0.001). Results were similar for cardiovascular-related and respiratory-related admissions, but no association remained for cancer-related hospitalisation after adjustment. Patterns were similar for each of the WBI domains and all-cause hospitalisations. CONCLUSION AND RELEVANCE Community well-being is inversely associated with local hospitalisation rates. In addition to health and quality-of-life benefits, higher community well-being may also result in fewer unnecessary hospitalisations.
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Affiliation(s)
- Brita Roy
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carley Riley
- Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jeph Herrin
- Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut, USA
| | - Erica Spatz
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut, USA
| | | | | | | | - Harlan Krumholz
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut, USA
- Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
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22
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Monma T, Takeda F, Noguchi H, Takahashi H, Watanabe T, Tamiya N. Exercise or sports in midlife and healthy life expectancy: an ecological study in all prefectures in Japan. BMC Public Health 2019; 19:1238. [PMID: 31500600 PMCID: PMC6734340 DOI: 10.1186/s12889-019-7570-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the increase of overall life expectancy in Japan, effective and beneficial lifestyle approaches and practices are crucial for individuals to have a long, productive and healthy life. Although previous studies suggest that exercise or sports, especially when performed with others, from midlife level have a positive impact on enhancing healthy life expectancy, there is paucity of information regarding these contexts and possible associations. The present study intends to clarify the relationship between engagement in exercise or sports among middle-aged persons and healthy life expectancy through an ecological study in all prefectures in Japan. METHODS We tabulated (1) the ratios of middle-aged individuals engaged in exercise or sports and (2) the different methods by which they are engaged in exercise or sports for each prefecture by using data from the 2005-2010 Longitudinal Survey of Middle-aged and Elderly Persons by the Ministry of Health, Labour and Welfare of Japan. Weighted multiple linear regression analyses were performed by sex, using healthy life expectancy in 2010 of each prefecture calculated by Hashimoto (2013) as a criterion variable; indices of (1) and (2) of each year as explanatory variables; and age, living conditions, employment, and chronic diseases as adjusted variables. RESULTS For middle-aged males, the ratio of those engaged in exercise or sports in each year from 2005 to 2010 was positively correlated with healthy life expectancy; this relationship was found in the ratio of middle-aged engaging in exercise or sports "with families or friends". For females, such a relationship could only be found in the ratio of middle-aged females engaged in exercise or sports in 2008 and 2010, and those engaging in exercise or sports "with families or friends" in 2008. CONCLUSION Prefectures with a higher ratio of middle-aged individuals engaging in exercise or sports, especially when done with families or friends, have longer healthy life expectancies. This was particularly evident for males. Thus, exercise or sports with families or friends in midlife seems to be more effective in promoting healthy life expectancy for males than females in Japan.
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Affiliation(s)
- Takafumi Monma
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 305-8574, Japan.,Advanced Research Initiative for Human High Performance, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 305-8574, Japan.,Research and Development Center for Health Services, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 305-8575, Japan
| | - Fumi Takeda
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 305-8574, Japan. .,Advanced Research Initiative for Human High Performance, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 305-8574, Japan. .,Research and Development Center for Health Services, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 305-8575, Japan.
| | - Haruko Noguchi
- Research and Development Center for Health Services, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 305-8575, Japan.,Faculty of Political Science and Economics, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku-ku, Tokyo, 169-8050, Japan
| | - Hideto Takahashi
- Research and Development Center for Health Services, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 305-8575, Japan.,National Institute of Public Health, 2-3-6 Minami, Wako-shi, Saitama, 351-0197, Japan
| | - Taeko Watanabe
- Research and Development Center for Health Services, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 305-8575, Japan.,Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 305-8575, Japan
| | - Nanako Tamiya
- Research and Development Center for Health Services, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 305-8575, Japan.,Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 305-8575, Japan
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23
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Cramm JM, Nieboer AP. Acculturation is associated with older Turkish immigrants' self-management abilities. BMC Public Health 2019; 19:1228. [PMID: 31488086 PMCID: PMC6727562 DOI: 10.1186/s12889-019-7471-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The few previous studies investigating acculturation and self-management have suggested that increased participation in (or adaptation to) the host culture is associated with better health and disease management. However, research on the relationship between acculturation strategies (attachment to the Dutch and Turkish cultures) and broader self-management abilities among older Turkish immigrants in the Netherlands is lacking. This study aimed to investigate this relationship in this population. METHODS Turkish immigrants aged > 65 years and residing in Rotterdam, the Netherlands (n = 2350), were identified using the municipal register. In total, 680 respondents completed the questionnaire (32% response rate). RESULTS The average age of the respondents was 72.90 (standard deviation, 5.02; range, 66-95) years and 47.6% of respondents were women. The majority (80.3%) of respondents reported having low educational levels. Women, single individuals, less-educated respondents, and those with multimorbidity experienced lower levels of attachment to the Dutch culture and reported poorer self-management abilities. Slightly stronger relationships were found between self-management and attachment to the Dutch culture than attachment to the Turkish culture. Multimorbidity negatively affected the self-management abilities of older Turkish people living in the Netherlands. CONCLUSIONS The study findings indicate that especially attachment to the Dutch culture matters for the self-management abilities of older Turkish immigrants in the Netherlands. Given the high prevalence of multimorbidity in this population, investment in their self-management abilities is expected to be beneficial. Special attention is needed for women, single individuals, less-educated people, and those with multimorbidity. Interventions aiming to better integrate these groups into Dutch society are also expected to be beneficial for their self-management abilities.
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Affiliation(s)
- Jane M Cramm
- Department of Social Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, The Netherlands.
| | - Anna P Nieboer
- Department of Social Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, The Netherlands
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24
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Obese mice exposed to psychosocial stress display cardiac and hippocampal dysfunction associated with local brain-derived neurotrophic factor depletion. EBioMedicine 2019; 47:384-401. [PMID: 31492565 PMCID: PMC6796537 DOI: 10.1016/j.ebiom.2019.08.042] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Obesity and psychosocial stress (PS) co-exist in individuals of Western society. Nevertheless, how PS impacts cardiac and hippocampal phenotype in obese subjects is still unknown. Nor is it clear whether changes in local brain-derived neurotrophic factor (BDNF) account, at least in part, for myocardial and behavioral abnormalities in obese experiencing PS. METHODS In adult male WT mice, obesity was induced via a high-fat diet (HFD). The resident-intruder paradigm was superimposed to trigger PS. In vivo left ventricular (LV) performance was evaluated by echocardiography and pressure-volume loops. Behaviour was indagated by elevated plus maze (EPM) and Y-maze. LV myocardium was assayed for apoptosis, fibrosis, vessel density and oxidative stress. Hippocampus was analyzed for volume, neurogenesis, GABAergic markers and astrogliosis. Cardiac and hippocampal BDNF and TrkB levels were measured by ELISA and WB. We investigated the pathogenetic role played by BDNF signaling in additional cardiac-selective TrkB (cTrkB) KO mice. FINDINGS When combined, obesity and PS jeopardized LV performance, causing prominent apoptosis, fibrosis, oxidative stress and remodeling of the larger coronary branches, along with lower BDNF and TrkB levels. HFD/PS weakened LV function similarly in WT and cTrkB KO mice. The latter exhibited elevated LV ROS emission already at baseline. Obesity/PS augmented anxiety-like behaviour and impaired spatial memory. These changes were coupled to reduced hippocampal volume, neurogenesis, local BDNF and TrkB content and augmented astrogliosis. INTERPRETATION PS and obesity synergistically deteriorate myocardial structure and function by depleting cardiac BDNF/TrkB content, leading to augmented oxidative stress. This comorbidity triggers behavioral deficits and induces hippocampal remodeling, potentially via lower BDNF and TrkB levels. FUND: J.A. was in part supported by Rotary Foundation Global Study Scholarship. G.K. was supported by T32 National Institute of Health (NIH) training grant under award number 1T32AG058527. S.C. was funded by American Heart Association Career Development Award (19CDA34760185). G.A.R.C. was funded by NIH (K01HL133368-01). APB was funded by a Grant from the Friuli Venezia Giulia Region entitled: "Heart failure as the Alzheimer disease of the heart; therapeutic and diagnostic opportunities". M.C. was supported by PRONAT project (CNR). N.P. was funded by NIH (R01 HL136918) and by the Magic-That-Matters fund (JHU). V.L. was in part supported by institutional funds from Scuola Superiore Sant'Anna (Pisa, Italy), by the TIM-Telecom Italia (WHITE Lab, Pisa, Italy), by a research grant from Pastificio Attilio Mastromauro Granoro s.r.l. (Corato, Italy) and in part by ETHERNA project (Prog. n. 161/16, Fondazione Pisa, Italy). Funding source had no such involvement in study design, in the collection, analysis, interpretation of data, in the writing of the report; and in the decision to submit the paper for publication.
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Rodgers M, Thomas S, Dalton J, Harden M, Eastwood A. Police-related triage interventions for mental health-related incidents: a rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Police officers are often the first responders to mental health-related incidents and, consequently, can become a common gateway to care. The volume of such calls is an increasing challenge.
Objective
What is the evidence base for models of police-related mental health triage (often referred to as ‘street triage’) interventions?
Design
Rapid evidence synthesis.
Participants
Individuals perceived to be experiencing mental ill health or in a mental health crisis.
Interventions
Police officers responding to calls involving individuals experiencing perceived mental ill health or a mental health crisis, in the absence of suspected criminality or a criminal charge.
Main outcome measures
Inclusion was not restricted by outcome.
Data sources
Eleven bibliographic databases (i.e. Applied Social Sciences Index and Abstracts, Criminal Justice Abstracts, EMBASE, MEDLINE, PAIS® Index, PsycINFO, Scopus, Social Care Online, Social Policy & Practice, Social Sciences Citation Index and Social Services Abstracts) and multiple online sources were searched for relevant systematic reviews and qualitative studies from inception to November 2017. Additional primary studies reporting quantitative data published from January 2016 were also sought.
Review methods
The three-part rapid evidence synthesis incorporated metasynthesis of the effects of street triage-type intervention models, rapid synthesis of UK-relevant qualitative evidence on implementation and the overall synthesis.
Results
Five systematic reviews, eight primary studies reporting quantitative data and eight primary studies reporting qualitative data were included. Most interventions involved police officers working in partnership with mental health professionals. These interventions were generally valued by staff and showed some positive effects on procedures (such as rates of detention) and resources, although these results were not entirely consistent and not all important outcomes were measured. Most of the evidence was at risk of multiple biases caused by design flaws and/or a lack of reporting of methods, which might affect the results.
Limitations
All primary research was conducted in England, so may not be generalisable to the whole of the UK. Discussion of health equity issues was largely absent from the evidence.
Conclusions
Most published evidence that aims to describe and evaluate various models of street triage interventions is limited in scope and methodologically weak. Several systematic reviews and recent studies have called for a prospective, comprehensive and streamlined collection of a wider variety of data to evaluate the impact of these interventions. This rapid evidence synthesis expands on these recommendations to outline detailed implications for research, which includes clearer articulation of the intervention’s objectives, measurement of quantitative outcomes beyond section 136 of the Mental Health Act 1983 [Great Britain. Mental Health Act 1983. Section 136. London: The Stationery Office; 1983 URL: www.legislation.gov.uk/ukpga/1983/20/section/136 (accessed October 2017)] (i.e. rates, places of safety and processing data) and outcomes that are most important to the police, mental health and social care services and service users. Evaluations should take into consideration shorter-, medium- and longer-term effects. Whenever possible, study designs should have an appropriate concurrent comparator, for example by comparing the pragmatic implementation of collaborative street triage models with models that emphasise specialist training of police officers. The collection of qualitative data should capture dissenting views as well as the views of advocates. Any future cost-effectiveness analysis of these interventions should evaluate the impact across police, health and social services.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Sian Thomas
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Jane Dalton
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
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Reyes S, Giovannoni G, Thomson A. Social capital: Implications for neurology. Brain Behav 2019; 9:e01169. [PMID: 30536750 PMCID: PMC6346418 DOI: 10.1002/brb3.1169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 09/16/2018] [Accepted: 10/25/2018] [Indexed: 01/26/2023] Open
Abstract
Social capital (SC) is a broad term that encompasses the many resources derived from social connections. The contemporary study of SC in public health has deep roots in the related fields of sociology, economics, and politics. Its multidisciplinary nature and the varying potential ways it could affect individuals have resulted in different but overlapping models to approach SC in the health field. There are currently no standardized measures of SC, and even more challenging its impact on health outcomes seems to vary according to the level of analysis. Despite the accumulating evidence that supports a protective effect of SC on mental and physical health, and mortality, not enough attention has been paid to the potential drawbacks of SC. The role of SC in neurological disease is just beginning to be explored. Concerted efforts are needed to ensure that empirical evidence on SC could be properly translated into interventions for health-promoting purposes. In this paper, we review the current state of scientific knowledge on the subject of SC, with a focus on its application in the field of neurology.
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Affiliation(s)
- Saúl Reyes
- Queen Mary University of London, Blizard Institute, London, UK
| | - Gavin Giovannoni
- Queen Mary University of London, Blizard Institute, London, UK.,Barts and The London School of Medicine and Dentistry, London, UK
| | - Alison Thomson
- Queen Mary University of London, Blizard Institute, London, UK
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Butel J, Braun KL. The Role of Collective Efficacy in Reducing Health Disparities: A Systematic Review. FAMILY & COMMUNITY HEALTH 2019; 42:8-19. [PMID: 30431465 PMCID: PMC7012267 DOI: 10.1097/fch.0000000000000206] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many improvements in health equity are spearheaded by community collaborations working to change policy and social norms. But how can collective efficacy (CE), defined as the willingness and ability of a group to work toward a common good, be increased? Eight articles reporting on interventions aiming to reduce health disparities by improving CE were found for this systematic literature review. All studies showed improvements in CE and most found reduction in disparities, but operationalization of CE varied. Findings support a model of how CE can address health disparities, which can guide standardization of CE interventions and measures.
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Affiliation(s)
- Jean Butel
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu
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Hansen A, Hauge S, Hellesø R, Bergland Å. Purchasers' deliberations on psychosocial needs within the process of allocating healthcare services for older home-dwelling persons with dementia: a qualitative study. BMC Health Serv Res 2018; 18:746. [PMID: 30285719 PMCID: PMC6167900 DOI: 10.1186/s12913-018-3550-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 09/20/2018] [Indexed: 12/03/2022] Open
Abstract
Background Meeting psychosocial needs is a significant component of quality dementia care. To enable persons with dementia to live at home for as long as possible, a community healthcare service offering care where physical, social, psychological, cultural and spiritual needs are met, is recommended. A comprehensive allocation process is required to allocate individually tailored healthcare services. However, the allocation process for older home-dwelling persons with dementia, specifically for services to safeguard psychosocial needs, remains largely unexplored. Accordingly, this study aims to explore purchasers’ deliberations on psychosocial needs during the process of allocating healthcare services to older home-dwelling persons with dementia. Methods The study had a descriptive design with a qualitative approach. The primary data source was focus group interviews with purchasers who assess and allocate healthcare services. The interview data were supplemented by a review of administrative decisions made by the purchasers. Data from the focus group interviews were analysed using a descriptive and interpretive approach. Content analysis of the administrative decisions was conducted. Results The purchasers described the allocation process as challenging. The following four themes reflect the complexity of the allocation process: (i) an unfamiliar and unclear concept; (ii) a hierarchy of needs; (iii) an adjusting allocation process; (iv) a challenging documentation of administrative decisions. Conclusions The purchasers viewed a comprehensive allocation process as important. However, a web of different interplaying aspects prevented the purchasers from conducting a comprehensive need-led allocation process. Insufficient assessment or allocation threatens the adequate safeguarding of the psychosocial needs of persons with dementia. Having varied and sufficient services to allocate is of great importance, but is not sufficient. Psychosocial needs must be better incorporated as a significant element throughout the entire allocation process. Electronic supplementary material The online version of this article (10.1186/s12913-018-3550-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anette Hansen
- Department of Nursing Science, University of Oslo, Faculty of Medicine, Postbox 235, 3603, Kongsberg, Norway. .,Department of Nursing and Health Sciences and Centre for Care Research, University of South-Eastern Norway, Postbox 235, 3603, Kongsberg, Norway.
| | - Solveig Hauge
- Department of Nursing and Health Sciences and Centre for Care Research, University of South-Eastern Norway, Postbox 235, 3603, Kongsberg, Norway
| | - Ragnhild Hellesø
- Institute of Health and Society, Department of Nursing Science, University of Oslo, Faculty of Medicine, Postbox 1130 Blindern,, 0318, OSLO, Norway
| | - Ådel Bergland
- Lovisenberg Diaconal University College, Lovisenberggaten 15b, 0456, Oslo, Norway
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Schroeder K, Malone SK, McCabe E, Lipman T. Addressing the Social Determinants of Health: A Call to Action for School Nurses. J Sch Nurs 2018; 34:182-191. [PMID: 29343161 PMCID: PMC6083826 DOI: 10.1177/1059840517750733] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Social determinants of health (SDOH), the conditions in which children are born, grow, live, work or attend school, and age, impact child health and contribute to health disparities. School nurses must consider these factors as part of their clinical practice because they significantly and directly influence child well-being. We provide clinical guidance for addressing the SDOH when caring for children with three common health problems (obesity, insufficient sleep, and asthma). Given their unique role as school-based clinical experts, care coordinators, and student advocates, school nurses are well suited to serve as leaders in addressing SDOH.
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Affiliation(s)
- Krista Schroeder
- University of Pennsylvania School of Nursing, Philadelphia,
PA, USA
| | - Susan Kohl Malone
- Center for Sleep and Circadian Neurobiology, University of
Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Rory Meyers College of Nursing, New York University, New
York, NY, USA
| | - Ellen McCabe
- University of Pennsylvania School of Nursing, Philadelphia,
PA, USA
| | - Terri Lipman
- University of Pennsylvania School of Nursing, Philadelphia,
PA, USA
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30
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Dalton J, Thomas S, Harden M, Eastwood A, Parker G. Updated meta-review of evidence on support for carers. J Health Serv Res Policy 2018; 23:196-207. [PMID: 29768942 DOI: 10.1177/1355819618766559] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To update a 2010 meta-review of systematic reviews of effective interventions to support carers of ill, disabled, or older adults. In this article, we report the most promising interventions based on the best available evidence. Methods Rapid meta-review of systematic reviews published from January 2009 to 2016. Results Sixty-one systematic reviews were included (27 high quality, 25 medium quality, and nine low quality). The quality of reviews has improved since the original review, but primary studies remain limited in quality and quantity. Fourteen high quality reviews focused on carers of people with dementia, four on carers of those with cancer, four on carers of people with stroke, three on carers of those at the end of life with various conditions, and two on carers of people with mental health problems. Multicomponent interventions featured prominently, emphasizing psychosocial or psychoeducational content, education and training. Improved outcomes for carers were reported for mental health, burden and stress, and wellbeing or quality of life. Negative effects were reported in reviews of respite care. As with earlier work, we found little robust evidence on the cost-effectiveness of reviewed interventions. Conclusions There is no 'one size fits all' intervention to support carers. There is potential for effective support in specific groups of carers, such as shared learning, cognitive reframing, meditation, and computer-delivered psychosocial support for carers of people with dementia. For carers of people with cancer, effective support may include psychosocial interventions, art therapy, and counselling. Carers of people with stroke may also benefit from counselling. More good quality, theory-based, primary research is needed.
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Affiliation(s)
- Jane Dalton
- 1 Research Fellow, Centre for Reviews and Dissemination, University of York, UK
| | - Sian Thomas
- 1 Research Fellow, Centre for Reviews and Dissemination, University of York, UK
| | - Melissa Harden
- 2 Information Specialist, Centre for Reviews and Dissemination, University of York, UK
| | - Alison Eastwood
- 3 Professor of Research, Centre for Reviews and Dissemination, University of York, UK
| | - Gillian Parker
- 4 Professor of Social Policy Research, Social Policy Research Unit, University of York, UK
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Farrington C. Psychosocial impacts of hybrid closed-loop systems in the management of diabetes: a review. Diabet Med 2018; 35:436-449. [PMID: 29247547 DOI: 10.1111/dme.13567] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 12/13/2022]
Abstract
There is a pressing need for new treatment regimens that enable improved glycaemic control and reduced diabetes self-management burdens. Closed-loop, or artificial pancreas, systems represent one of the most promising avenues in this regard. Closed-loop systems connect wearable continuous glucose monitor (CGM) sensors to smartphone- or tablet-mounted algorithms that process and model CGM data to deliver precise and frequently updated doses of fast-acting insulin (and glucagon in dual-hormone systems) to users via wearable pumps. Recent studies have demonstrated that closed-loop systems offer significant benefit in terms of improved glycaemic control. However, less attention has been paid to the psychosocial impact on users of closed-loop systems. This article reviews recent research on psychosocial aspects of closed-loop usage in light of preceding research on user experience of currently available technologies such as insulin pumps and CGM sensors. The small, but growing body of research in this field reports generally positive user experience and a number of experienced benefits including: reassurance and reduced anxiety, improved sleep and confidence, and 'time off' from diabetes demands. However, these benefits are counterbalanced by important challenges, ranging from variable levels of trust to concerns about physical bulk, technical glitches and difficulties incorporating closed-loop systems into everyday life. Future research should explore psychosocial aspects of closed-loop usage in more diverse groups and with regard to clinicians, as well as users, to ensure that the clinical benefits of closed-loop systems are realized at scale in routine medical care.
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Affiliation(s)
- C Farrington
- Cambridge Centre for Health Services Research (CCHSR), Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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32
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Bennis I, De Brouwere V, Belrhiti Z, Sahibi H, Boelaert M. Psychosocial burden of localised cutaneous Leishmaniasis: a scoping review. BMC Public Health 2018; 18:358. [PMID: 29544463 PMCID: PMC5855994 DOI: 10.1186/s12889-018-5260-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/06/2018] [Indexed: 01/02/2023] Open
Abstract
Background Cutaneous Leishmaniasis (CL) is a parasitic skin disease, linked to poverty, and belonging to the group of Neglected Tropical Diseases. Depending on the severity, the type of lesions or scars, and the context, CL can lead to self- and social stigma influencing the quality of life and psychological well-being of the patient. This dimension is, however, little documented for the most common, localized form of cutaneous leishmaniasis (LCL). We aimed to describe the current knowledge on the psychological burden and the stigma related to LCL. Methods The population of interest for this scoping review are patients or their relatives with localized LCL or related scars. We searched the electronic databases PubMed, Web of Knowledge, PsycINFO, POPLINE, Cochrane Library, Science Direct, Global Health, and LILACS, for articles written in Arabic, English, French, Dutch, Portuguese, or Spanish, and published until the end of August 2017. Results From 2485 initial records, 15 papers met our inclusion criteria. Dermatology life quality index was the most frequent used scale to assess LCL psychological impact in quantitative studies. Six qualitative studies used individual interviews and/or focus groups discussions to explore the psychological and/or the social burden of this disease. Quantitative assessments using standard scales as well as qualitative research asserts that LCL is a source of psychological suffering, stigmatization, and decreased quality of life (QoL). Conclusion Most studies showed that LCL has a significant negative effect on the QoL and mental health. However, the fact that the psychosocial burden generated by LCL is time-dependent makes it hard to measure. We recommend to develop a more specific and validated assessment scale to appreciate the full burden of this disease and enhance comparability of findings. Electronic supplementary material The online version of this article (10.1186/s12889-018-5260-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Issam Bennis
- National School of Public Health, Ministry of Health, Lemfedel Cherkaoui Street, Madinat Al Irfane, 10000, Rabat, Morocco. .,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. .,Department of Biomedical Sciences, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium.
| | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Zakaria Belrhiti
- National School of Public Health, Ministry of Health, Lemfedel Cherkaoui Street, Madinat Al Irfane, 10000, Rabat, Morocco.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Vrije Universiteit Brussel, Rabat, Morocco
| | - Hamid Sahibi
- Department of Pathology and Veterinary Public Health, Hassan II Agronomy and Veterinary Institute, Rabat, Morocco
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Barcelona de Mendoza V, Harville EW, Savage J, Giarratano G. Experiences of Intimate Partner and Neighborhood Violence and Their Association With Mental Health in Pregnant Women. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:938-959. [PMID: 26576616 PMCID: PMC4870174 DOI: 10.1177/0886260515613346] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Both intimate partner violence and neighborhood crime have been associated with worse mental health outcomes, but less is known about cumulative effects. This association was studied in a sample of pregnant women who were enrolled in a study of disaster exposure, prenatal care, and mental and physical health outcomes between 2010 and 2012. Women were interviewed about their exposure to intimate partner violence and perceptions of neighborhood safety, crime, and disorder. Main study outcomes included symptoms of poor mental health; including depression, pregnancy-specific anxiety (PA), and posttraumatic stress disorder (PTSD). Logistic regression was used to examine predictors of mental health with adjustment for confounders. Women who experienced high levels of intimate partner violence and perceived neighborhood violence had increased odds of probable depression in individual models. Weighted high cumulative (intimate partner and neighborhood) experiences of violence were also associated with increased odds of having probable depression when compared with those with low violence. Weighed high cumulative violence was also associated with increased odds of PTSD. This study provides additional evidence that cumulative exposure to violence is associated with poorer mental health in pregnant women.
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Affiliation(s)
| | - Emily W Harville
- 1 Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Gloria Giarratano
- 3 Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Leiser S, Déruaz-Luyet A, N’Goran AA, Pasquier J, Streit S, Neuner-Jehle S, Zeller A, Haller DM, Herzig L, Bodenmann P. Determinants associated with deprivation in multimorbid patients in primary care-A cross-sectional study in Switzerland. PLoS One 2017; 12:e0181534. [PMID: 28738070 PMCID: PMC5524289 DOI: 10.1371/journal.pone.0181534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deprivation usually encompasses material, social, and health components. It has been shown to be associated with greater risks of developing chronic health conditions and of worse outcome in multimorbidity. The DipCare questionnaire, an instrument developed and validated in Switzerland for use in primary care, identifies patients subject to potentially higher levels of deprivation. OBJECTIVES To identifying determinants of the material, social, and health profiles associated with deprivation in a sample of multimorbid, primary care patients, and thus set priorities in screening for deprivation in this population. DESIGN Secondary analysis from a nationwide cross-sectional study in Switzerland. PARTICIPANTS A random sample of 886 adult patients suffering from at least three chronic health conditions. MAIN MEASURES The outcomes of interest were the patients' levels of deprivation as measured using the DipCare questionnaire. Classification And Regression Tree analysis identified the independent variables that separated the examined population into groups with increasing deprivation scores. Finally, a sensitivity analysis (multivariate regression) confirmed the robustness of our results. KEY RESULTS Being aged under 64 years old was associated with higher overall, material, and health deprivation; being aged over 77 years old was associated with higher social deprivation. Other variables associated with deprivation were the level of education, marital status, and the presence of depression or chronic pain. CONCLUSION Specific profiles, such as being younger, were associated with higher levels of overall, material, and health deprivation in multimorbid patients. In contrast, patients over 77 years old reported higher levels of social deprivation. Furthermore, chronic pain and depression added to the score for health deprivation. It is important that GPs consider the possibility of deprivation in these multimorbid patients and are able to identify it, both in order to encourage treatment adherence and limit any forgoing of care for financial reasons.
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Affiliation(s)
- Silja Leiser
- Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | - Anouk Déruaz-Luyet
- Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Jérôme Pasquier
- Institute of Preventive and Social Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Dagmar M. Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lilli Herzig
- Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Badri P, Wolfe R, Farmer A, Amin M. Psychosocial Determinants of Adherence to Preventive Dental Attendance for Preschool Children Among Filipino Immigrants in Edmonton, Alberta. J Immigr Minor Health 2017; 20:658-667. [DOI: 10.1007/s10903-017-0599-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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36
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Levasseur M, Roy M, Michallet B, St-Hilaire F, Maltais D, Généreux M. Associations Between Resilience, Community Belonging, and Social Participation Among Community-Dwelling Older Adults: Results From the Eastern Townships Population Health Survey. Arch Phys Med Rehabil 2017; 98:2422-2432. [PMID: 28455192 DOI: 10.1016/j.apmr.2017.03.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/24/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the associations between resilience, community belonging, and social participation, and the moderating effect of resilience on the association between community belonging and social participation among community-dwelling older adults. DESIGN Cross-sectional; secondary analyses of the Eastern Townships Population Health Survey. SETTING Community. PARTICIPANTS A sample (N=4541) of women (n=2485) and men (n=2056) aged ≥60 years was randomly selected according to area. Most participants had <14 years of schooling, owned their dwelling, were retired, had 1 or 2 chronic conditions, and did not have depressive symptoms. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-reported data on age, education, depressive symptoms, social participation, community belonging, and resilience were collected by phone interviewer-administered questionnaire. A social participation scale measured frequency of participation in 8 community activities. A 4-point Likert scale ranging from "very strong" to "very weak" estimated sense of belonging to the local community. Social participation and sense of belonging questions came from Statistics Canada surveys. Resilience was assessed with the 10-item Connor-Davidson Resilience Scale, capturing the ability to cope with adversity. RESULTS Controlling for age, education, and psychological distress, greater resilience and community belonging were associated with greater social participation among women (R2=.13; P<.001) and men (R2=.09; P<.001). The association between community belonging and social participation varied as a function of resilience, especially in men. Greater community belonging further enhanced social participation, especially among women (P=.03) and men (P<.01) with greater resilience (moderator effect). CONCLUSIONS Resilience moderates the association between community belonging and social participation among community-dwelling older women and, especially, men. Interventions targeting social participation should consider the potential impact of resilience on improving community belonging. Future studies should investigate why resilience moderates associations between community belonging and social participation, and how to enhance resilience among older adults.
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Affiliation(s)
- Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada; Research Centre on Aging, Health and Social Services Centre-Eastern Townships Integrated University Centre for Health & Social Services-Sherbrooke Hospital University Centre (CIUSSS de l'Estrie-CHUS), Sherbrooke, Québec, Canada; Interdisciplinary Research Group on Resilience, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Québec, Canada.
| | - Mathieu Roy
- Interdisciplinary Research Group on Resilience, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Québec, Canada; Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada; CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada
| | - Bernard Michallet
- Interdisciplinary Research Group on Resilience, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Québec, Canada; Department of Speech Language Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - France St-Hilaire
- Department of Management and Human Resources, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Danielle Maltais
- Department of Human and Social Sciences, Université du Québec à Chicoutimi, Saguenay, Québec, Canada
| | - Mélissa Généreux
- Research Centre on Aging, Health and Social Services Centre-Eastern Townships Integrated University Centre for Health & Social Services-Sherbrooke Hospital University Centre (CIUSSS de l'Estrie-CHUS), Sherbrooke, Québec, Canada; CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada; Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Thomas S, Dalton J, Harden M, Eastwood A, Parker G. Updated meta-review of evidence on support for carers. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05120] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundPolicy and research interest in carers continues to grow. A previous meta-review, published in 2010, by Parkeret al.(Parker G, Arksey H, Harden M.Meta-review of International Evidence on Interventions to Support Carers. York: Social Policy Research Unit, University of York; 2010) found little compelling evidence of effectiveness about specific interventions and costs.ObjectiveTo update what is known about effective interventions to support carers of ill, disabled or older adults.DesignRapid meta-review.SettingAny relevant to the UK health and social care system.ParticipantsCarers (who provide support on an unpaid basis) of adults who are ill, disabled or older.InterventionsAny intervention primarily aimed at carers.Main outcome measuresAny direct outcome for carers.Data sourcesDatabase searches (including Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, Applied Social Sciences Index and Abstracts and Social Care Online) for systematic reviews published from January 2009 to 2016.Review methodsWe used EndNote X7.4 (Thomson Reuters, CA, USA) to screen titles and abstracts. Final decisions on the inclusion of papers were made by two reviewers independently, using a Microsoft Excel®2013 spreadsheet (Microsoft Corporation, Redmond, WA, USA). We carried out a narrative synthesis structured by patient condition and by seven outcomes of interest. We assessed the quality of the included systematic reviews using established criteria. We invited a user group of carers to give their views on the overall findings of our review.ResultsSixty-one systematic reviews were included (27 of high quality, 25 of medium quality and nine of low quality). Patterns in the literature were similar to those in earlier work. The quality of reviews had improved, but primary studies remained limited in quality and quantity. Of the high-quality reviews, 14 focused on carers of people with dementia, four focused on carers of those with cancer, four focused on carers of people with stroke, three focused on carers of those at the end of life with various conditions and two focused on carers of people with mental health problems. Multicomponent interventions featured prominently, emphasising psychosocial or psychoeducational content, education and training. Multiple outcomes were explored, primarily in mental health, burden and stress, and well-being or quality of life. Negative effects following respite care were unsupported by our user group. As with earlier work, we found little evidence on intervention cost-effectiveness. No differences in review topics were found across high-, medium- and low-quality reviews.LimitationsThe nature of meta-reviews precludes definitive conclusions about intervention effectiveness, for whom and why. Many of the included reviews were small in size and authors generally relied on small numbers of studies to underpin their conclusions. The meta-review was restricted to English-language publications. Short timescales prevented any investigation of the overlap of primary studies, and growth in the evidence base since the original meta-review meant that post-protocol decisions were necessary.ConclusionsThere is no ‘one size fits all’ intervention to support carers. Potential exists for effective support in specific groups of carers. This includes shared learning, cognitive reframing, meditation and computer-delivered psychosocial support for carers of people with dementia, and psychosocial interventions, art therapy and counselling for carers of people with cancer. Counselling may also help carers of people with stroke. The effectiveness of respite care remains a paradox, given the apparent conflict between the empirical evidence and the views of carers.Future workMore good-quality, theory-based, primary research is warranted. Evidence is needed on the differential impact of interventions for various types of carers (including young carers and carers from minority groups), and on the effectiveness of constituent parts in multicomponent programmes. Further research triangulating qualitative and quantitative evidence on respite care is urgently required. The overlap of primary studies was not formally investigated in our review, and this warrants future evaluation.Study registrationThis study is registered as PROSPERO CRD42016033367.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Sian Thomas
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Jane Dalton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Gillian Parker
- Social Policy Research Unit, University of York, York, UK
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Mikelyte R, Milne A. The role and influence of micro-cultures in long-term care on the mental health and wellbeing of older people: a scoping review of evidence. QUALITY IN AGEING AND OLDER ADULTS 2016. [DOI: 10.1108/qaoa-09-2015-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Huang YHC, Wu F, Cheng Y. Crisis communication in context: Cultural and political influences underpinning Chinese public relations practice. PUBLIC RELATIONS REVIEW 2016; 42:201-213. [PMID: 32288052 PMCID: PMC7126396 DOI: 10.1016/j.pubrev.2015.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/23/2015] [Indexed: 06/11/2023]
Abstract
This study analyzes academic journal articles in order to depict the features of Chinese crisis communication in Mainland China, Hong Kong, and Taiwan. The findings revealed the following features of crisis communication in Chinese societies: collectivistic culture, nationalism, rationalism, face-giving/saving, striving for the "golden mean," the preference for passive communicative strategies, and the avoidance of extreme strategies. Nevertheless, the differences in political systems-the ubiquitous intervention by authoritarian government on the Mainland, the mistrust of government in post-handover Hong Kong, and the relatively mature democratic polity in Taiwan all lead to unique crisis communication practices.
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Affiliation(s)
- Yi-Hui Christine Huang
- School of Journalism and Communication, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Fang Wu
- School of Journalism and Communication, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Yang Cheng
- Missouri School of Journalism, 140-E Walter Williams Hall, Missouri School of Journalism, Columbia, MO 65211, USA
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Lovell R, Husk K, Cooper C, Stahl-Timmins W, Garside R. Understanding how environmental enhancement and conservation activities may benefit health and wellbeing: a systematic review. BMC Public Health 2015; 15:864. [PMID: 26346542 PMCID: PMC4561424 DOI: 10.1186/s12889-015-2214-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Action taken to enhance or conserve outdoor environments may benefit health and wellbeing through the process of participation but also through improving the environment. There is interest, amongst both health and environmental organisations, in using such activities as health promotion interventions. The objective of this systematic review was to investigate the health and wellbeing impacts of participation in environmental enhancement and conservation activities and to understand how these activities may be beneficial, to whom and in what circumstances or contexts. METHODS A theory-led mixed-method systematic review was used to assess evidence of effect and to identify pathways to change (protocol: http://onlinelibrary.wiley.com/doi/ 10.1002/14651858.CD010351/full ). Due to the multi-disciplinary, dispersed and disparate body of evidence an extensive multi-stage search strategy was devised and undertaken. Twenty-seven databases and multiple sources of grey literature were searched and over 200 relevant organisations were contacted. The heterogenous evidence was synthesised using a narrative approach and a conceptual model was developed to illustrate the mechanisms of effect. Due to the limited nature of the evidence additional higher order evidence was sought to assess the plausibility of the proposed mechanisms of effect through which health and wellbeing may accrue. RESULTS The majority of the quantitative evidence (13 studies; all poor quality and lower-order study designs) was inconclusive, though a small number of positive and negative associations were observed. The qualitative evidence (13 studies; 10 poor quality, 3 good) indicated that the activities were perceived to have value to health and wellbeing through a number of key mechanisms; including exposure to natural environments, achievement, enjoyment and social contact. Additional high level evidence indicated that these pathways were plausible. CONCLUSIONS Despite interest in the use of environmental enhancement activities as a health intervention there is currently little direct evidence of effect, this is primarily due to a lack of robust study designs. Further rigorous research is needed to understand the potential of the activities to benefit health and environment.
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Affiliation(s)
- Rebecca Lovell
- European Centre for Environment and Human Health, University of Exeter Medical School, RCHT, Truro, TR1 3HD, UK.
| | - Kerryn Husk
- European Centre for Environment and Human Health, University of Exeter Medical School, RCHT, Truro, TR1 3HD, UK.,NIHR CLAHRC South West Peninsula (PenCLAHRC), Plymouth University Peninsula Schools of Medicine and Dentistry, ITTC Building, Tamar Science Park, Plymouth, PL6 8BX, UK
| | - Chris Cooper
- University of Exeter Medical School, Peninsula Technology Assessment Group, Veysey Building, Exeter, EX2 4SG, UK
| | - Will Stahl-Timmins
- European Centre for Environment and Human Health, University of Exeter Medical School, RCHT, Truro, TR1 3HD, UK.,BMJ, BMA House, Tavistock Square, London, WC1H, 9JR, UK
| | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter Medical School, RCHT, Truro, TR1 3HD, UK
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Gelormino E, Melis G, Marietta C, Costa G. From built environment to health inequalities: An explanatory framework based on evidence. Prev Med Rep 2015; 2:737-45. [PMID: 26844145 PMCID: PMC4721462 DOI: 10.1016/j.pmedr.2015.08.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The Health in All Policies strategy aims to engage every policy domain in health promotion. The more socially disadvantaged groups are usually more affected by potential negative impacts of policies if they are not health oriented. The built environment represents an important policy domain and, apart from its housing component, its impact on health inequalities is seldom assessed. METHODS A scoping review of evidence on the built environment and its health equity impact was carried out, searching both urban and medical literature since 2000 analysing socio-economic inequalities in relation to different components of the built environment. RESULTS The proposed explanatory framework assumes that key features of built environment (identified as density, functional mix and public spaces and services), may influence individual health through their impact on both natural environment and social context, as well as behaviours, and that these effects may be unequally distributed according to the social position of individuals. CONCLUSION In general, the expected links proposed by the framework are well documented in the literature; however, evidence of their impact on health inequalities remains uncertain due to confounding factors, heterogeneity in study design, and difficulty to generalize evidence that is still very embedded to local contexts.
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Affiliation(s)
- Elena Gelormino
- Department of Public Health, Local Health Authority TO5, Piedmont Region, Italy
| | - Giulia Melis
- Environmental Heritage and Urban Redevelopment — SiTI Higher Institute on Territorial Systems for Innovation, Turin, via Pier Carlo Boggio 61, 10138 Torino, Italy
| | - Cristina Marietta
- Environmental Heritage and Urban Redevelopment Unit — SiTI Higher Institute on Territorial Systems for Innovation, Turin, via Pier Carlo Boggio 61, 10138 Torino, Italy
| | - Giuseppe Costa
- Department of Clinical and Biological Sciences, University of Turin, Turin, via Sabaudia 94, 10095 Grugliasco, Torino, Italy
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Landstedt E, Gustafsson PE, Johansson K, Hammarström A. Longitudinal associations between social relationships at age 30 and internalising symptoms at age 42: findings from the Northern Swedish Cohort. Int J Public Health 2015; 61:75-81. [PMID: 26024816 DOI: 10.1007/s00038-015-0691-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 02/20/2015] [Accepted: 05/11/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Little is known on long-term consequences of poor social relationships in adulthood. The study aimed to examine associations between social relationships at age 30 and internalising symptoms at age 42. METHODS Data was drawn from four waves of the Northern Swedish cohort (n = 1001, 94 % response rate). The outcome internalising symptoms was measured by a composite index of depressiveness and anxiety. A cumulative measure was constructed to reflect various aspects of social relationships. Multivariate ordinal logistic regressions were used, controlling for socioeconomic indicators and previous level of internalising symptoms. RESULTS An accumulation of poor social relationships indicators at age 30 is related to internalising symptoms at age 42 in women (OR 1.30; CI 1.11-1.52) and men (OR 1.17; CI 1.02-1.36). The associations remained significant after adjustment for covariates. CONCLUSIONS Poor quality of social relationships at age 30 can predict internalising symptoms 12 years later in both men and women even when previous mental health as well as financial disadvantage is accounted for. More research is required to further examine pathways and mechanisms as well as suitable interventions.
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Affiliation(s)
- Evelina Landstedt
- Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, Norrland University Hospital, 90185, Umeå, Sweden.
| | - Per E Gustafsson
- Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, Norrland University Hospital, 90185, Umeå, Sweden
| | - Klara Johansson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Anne Hammarström
- Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, Norrland University Hospital, 90185, Umeå, Sweden
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Physiotherapists' assessment of patients' psychosocial status: Are we standing on thin ice? A qualitative descriptive study. ACTA ACUST UNITED AC 2015; 20:328-34. [DOI: 10.1016/j.math.2014.10.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 06/25/2014] [Accepted: 10/07/2014] [Indexed: 11/19/2022]
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The role of material, psychosocial and behavioral factors in mediating the association between socioeconomic position and allostatic load (measured by cardiovascular, metabolic and inflammatory markers). Brain Behav Immun 2015; 45:41-9. [PMID: 25459100 PMCID: PMC4349498 DOI: 10.1016/j.bbi.2014.10.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/17/2014] [Accepted: 10/10/2014] [Indexed: 11/20/2022] Open
Abstract
Lower socioeconomic position (SEP), both accumulated across the life course and at different life-stages, has been found to be associated with higher cumulative physiological burden, as measured by allostatic load. This study aimed to identify what factors mediate the association between SEP and allostatic load, as measured through combining cardiovascular, metabolic and inflammatory markers. We explored the role of material, psychological and behavioral factors, accumulated across two periods in time, in mediating the association between SEP and allostatic load. Data are from the West of Scotland Twenty-07 Study, with respondents followed over five waves of data collection from ages 35 to 55 (n=999). Allostatic load was measured by summing nine binary biomarker scores ('1'=in the highest-risk quartile) measured when respondents were 55years old (wave 5). SEP was measured by a person's accumulated social class over two periods All mediators and SEP were measured at baseline in 1987 and 20years later and combined to form accumulated measures of risk. Material mediators included car and home ownership, and having low income. The General Health Questionnaire (GHQ-12) was used as the psychosocial mediator. Behavioral mediators included smoking, alcohol consumption, physical activity and diet. Path analysis using linear regressions adjusting for sex were performed for each of the potential mediators to assess evidence of attenuation in the association between lower SEP and higher allostatic load. Analyses by mediator type revealed that renting one's home (approximately 78% attenuation) and having low income (approx. 62% attenuation) largely attenuated the SEP-allostatic load association. GHQ did not attenuate the association. Smoking had the strongest attenuating effect of all health behaviors (by 33%) with no other health behaviors attenuating the association substantially. Material factors, namely home tenure and income status, and smoking have important roles in explaining socioeconomic disparities in allostatic load, particularly when accumulated over time.
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Smalls BL, Walker RJ, Bonilha HS, Campbell JA, Egede LE. Community Interventions to Improve Glycemic Control in African Americans with Type 2 Diabetes: A Systemic Review. Glob J Health Sci 2015; 7:171-82. [PMID: 26156923 PMCID: PMC4803865 DOI: 10.5539/gjhs.v7n5p171] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/06/2015] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The purpose of this study was to conduct a systematic review of published community interventions to evaluate different components of community interventions and their ability to positively impact glycemic control in African Americans with T2DM. METHODS Medline, PsychInfo, and CINAHL were searched for potentially eligible studies published from January 2000 through January 2012. The following inclusion criteria were established for publications: (1) describe a community intervention, not prevention; (2) specifically indicate, in data analysis and results, the impact of the community intervention on African American adults, 18 years and older; (3) measure glycemic control (HbA1C) as an outcome measure; and (4) involve patients in a community setting, which excludes hospitals and hospital clinics. RESULTS Thirteen studies out of 9,233 articles identified in the search met the predetermined inclusion criteria. There were 5 randomized control trials and 3 reported improved glycemic control in the intervention group compared to the control group at the completion of the study. Of the 8 studies that were not randomized control trials, 6 showed a statistically significant change in HbA1C. CONCLUSION In general, the community interventions assessed led to significant reductions in HbA1C in African Americans with type 2 diabetes. Community health workers did not have a greater impact on glycemic control in this sample. The findings of this study provides insight for designing community-based interventions in the future, such as including use of multiple delivery methods, consideration of mobile device software, nutritionist educator, and curriculum-based approaches.
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Gabardo MCL, Moysés SJ, Moysés ST, Olandoski M, Olinto MTA, Pattussi MP. Multilevel analysis of self-perception in oral health and associated factors in Southern Brazilian adults: a cross-sectional study. CAD SAUDE PUBLICA 2015; 31:49-59. [DOI: 10.1590/0102-311x00037814] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 08/05/2014] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the association between individual and contextual variables related to self-perception in oral health among residents in the municipality of São Leopoldo, Rio Grande do Sul State, Brazil. The cross-sectional design involved 1,100 adults in 38 census tracts. The self-perception was evaluated using the Oral Health Impact Profile (OHIP-14) tool. A logistic multilevel analysis was performed. The multivariate analysis revealed that those who are of the female gender, older, with lower scores of quality of life and less social support, with poor healthy eating habits, smokers and those living in low-income census tracts presented higher odds of reporting worse oral health self-perception (OHIP-1). We concluded that individual and contextual variables are associated with oral health self-perception. This is essential information for planning health services wishing to meet the health needs of the population.
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Freak-Poli RLA, Wolfe R, Wong E, Peeters A. Change in well-being amongst participants in a four-month pedometer-based workplace health program. BMC Public Health 2014; 14:953. [PMID: 25224301 PMCID: PMC4180736 DOI: 10.1186/1471-2458-14-953] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 08/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing uptake of workplace physical activity programs to prevent chronic disease. While they are frequently evaluated for improvement in biomedical risk factors there has been little evaluation of additional benefits for psychosocial health. We aimed to evaluate whether participation in a four-month, team-based, pedometer-based workplace health program known to improve biomedical risk factors is associated with an improvement in well-being, immediately after the program and eight-months after program completion. METHODS At baseline (2008), 762 adults (aged 40 ± 10 SD years, 42% male) employed in primarily sedentary occupations and voluntarily enrolled in a physical activity program were recruited from ten Australian worksites. Data was collected at baseline, at the completion of the four-month program and eight-months after program completion. The outcome was the WHO-Five Well-being Index (WHO-5), a self-administered five-item scale that can be dichotomised as 'poor' (less than 52%) or 'positive' (more than or equal to 52%) well-being. RESULTS At baseline, 75% of participants had positive well-being (mean: 60 ± 19 SD WHO-5 units). On average, well-being improved immediately after the health program (+3.5 units, p < 0.001) and was sustained eight-months later (+3.4 units from baseline, p < 0.001). In the 25% with poor well-being at baseline, 49.5% moved into the positive well-being category immediately after program completion, sustained eight-months later (p < 0.001). CONCLUSIONS Clinically relevant immediate and sustained improvements in well-being were observed after participation in the health program. These results suggest that participation in workplace programs, such as the one evaluated here, also has the potential to improve well-being.
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Affiliation(s)
- Rosanne LA Freak-Poli
- />BakerIDI Heart and Diabetes Institute, Melbourne, Australia
- />Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- />Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rory Wolfe
- />Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Evelyn Wong
- />BakerIDI Heart and Diabetes Institute, Melbourne, Australia
- />Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anna Peeters
- />BakerIDI Heart and Diabetes Institute, Melbourne, Australia
- />Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Pogosova N, Saner H, Pedersen SS, Cupples ME, McGee H, Höfer S, Doyle F, Schmid JP, von Känel R. Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology. Eur J Prev Cardiol 2014; 22:1290-306. [PMID: 25059929 DOI: 10.1177/2047487314543075] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/20/2014] [Indexed: 12/18/2022]
Abstract
A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.
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Affiliation(s)
- Nana Pogosova
- Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia
| | - Hugo Saner
- Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Denmark Department of Cardiology, Odense University Hospital, Denmark
| | - Margaret E Cupples
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University, Belfast, UK
| | - Hannah McGee
- Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland
| | - Stefan Höfer
- Medical Psychology, Innsbruck Medical University, Austria
| | - Frank Doyle
- Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland
| | - Jean-Paul Schmid
- Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland
| | - Roland von Känel
- Department of Neurology, Bern University Hospital, Switzerland Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
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Phillips G, Bottomley C, Schmidt E, Tobi P, Lais S, Yu G, Lynch R, Lock K, Draper A, Moore D, Clow A, Petticrew M, Hayes R, Renton A. Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods. J Epidemiol Community Health 2014; 68:606-14. [PMID: 24489043 PMCID: PMC4112422 DOI: 10.1136/jech-2013-202505] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND We report the main results, among adults, of a cluster-randomised-trial of Well London, a community-engagement programme promoting healthy eating, physical activity and mental well-being in deprived neighbourhoods. The hypothesis was that benefits would be neighbourhood-wide, and not restricted to intervention participants. The trial was part of a multicomponent process/outcome evaluation which included non-experimental components (self-reported behaviour change amongst participants, case studies and evaluations of individual projects) which suggested health, well-being and social benefits to participants. METHODS Twenty matched pairs of neighbourhoods in London were randomised to intervention/control condition. Primary outcomes (five portions fruit/vegetables/day; 5×30 m of moderate intensity physical activity/week, abnormal General Health Questionnaire (GHQ)-12 score and Warwick-Edinburgh Mental Well-being Scale (WEMWBS) score) were measured by postintervention questionnaire survey, among 3986 adults in a random sample of households across neighbourhoods. RESULTS There was no evidence of impact on primary outcomes: healthy eating (relative risk [RR] 1.04, 95% CI 0.93 to 1.17); physical activity (RR:1.01, 95% CI 0.88 to 1.16); abnormal GHQ12 (RR:1.15, 95% CI 0.84 to 1.61); WEMWBS (mean difference [MD]: -1.52, 95% CI -3.93 to 0.88). There was evidence of impact on some secondary outcomes: reducing unhealthy eating-score (MD: -0.14, 95% CI -0.02 to 0.27) and increased perception that people in the neighbourhood pulled together (RR: 1.92, 95% CI 1.12 to 3.29). CONCLUSIONS The trial findings do not provide evidence supporting the conclusion of non-experimental components of the evaluation that intervention improved health behaviours, well-being and social outcomes. Low participation rates and population churn likely compromised any impact of the intervention. Imprecise estimation of outcomes and sampling bias may also have influenced findings. There is a need for greater investment in refining such programmes before implementation; new methods to understand, longitudinally different pathways residents take through such interventions and their outcomes, and new theories of change that apply to each pathway.
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Affiliation(s)
- Gemma Phillips
- Institute for Health and Human Development, University of East London, London,UK
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Elena Schmidt
- Institute for Health and Human Development, University of East London, London,UK
| | - Patrick Tobi
- Institute for Health and Human Development, University of East London, London,UK
| | - Shahana Lais
- Institute for Health and Human Development, University of East London, London,UK
| | - Ge Yu
- Institute for Health and Human Development, University of East London, London,UK
| | - Rebecca Lynch
- Department of Psychology, University of Westminster, London, UK
| | - Karen Lock
- London School of Hygiene and Tropical Medicine, London, UK
| | - Alizon Draper
- Department of Human and Health Sciences, University of Westminster, London, UK
| | - Derek Moore
- Institute for Research on Child Development, University of East London, London, UK
| | - Angela Clow
- Department of Psychology, University of Westminster, London, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Adrian Renton
- Institute for Health and Human Development, University of East London, London,UK
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Derges J, Clow A, Lynch R, Jain S, Phillips G, Petticrew M, Renton A, Draper A. 'Well London' and the benefits of participation: results of a qualitative study nested in a cluster randomised trial. BMJ Open 2014; 4:e003596. [PMID: 24694622 PMCID: PMC3987724 DOI: 10.1136/bmjopen-2013-003596] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Well London is a multicomponent community engagement and coproduction programme designed to improve the health of Londoners living in socioeconomically deprived neighbourhoods. To evaluate outcomes of the Well London interventions, a cluster randomised trial (CRT) was conducted that included a longitudinal qualitative component, which is reported here. The aim is to explore in depth the nature of the benefits to residents and the processes by which these were achieved. METHODS The 1-year longitudinal qualitative study was nested within the CRT. Purposive sampling was used to select three intervention neighbourhoods in London and 61 individuals within these neighbourhoods. The interventions comprised activities focused on: healthy eating, physical exercise and mental health and well-being. Interviews were conducted at the inception and following completion of the Well London interventions to establish both if and how they had participated. Transcripts of the interviews were coded and analysed using Nvivo. RESULTS Positive benefits relating to the formal outcomes of the CRT were reported, but only among those who participated in project activities. The extent of benefits experienced was influenced by factors relating to the physical and social characteristics of each neighbourhood. The highest levels of change occurred in the presence of: (1) social cohesion, not only pre-existing but also as facilitated by Well London activities; (2) personal and collective agency; (3) involvement and support of external organisations. Where the physical and social environment remained unchanged, there was less participation and fewer benefits. CONCLUSIONS These findings show interaction between participation, well-being and agency, social interactions and cohesion and that this modulated any benefits described. Pathways to change were thus complex and variable, but personal well-being and local social cohesion emerged as important mediators of change.
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Affiliation(s)
- Jane Derges
- School of Life Sciences, University of Westminster, London, UK
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