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Daucé-Fleuret L, Reilhac A, Alleton N, Somme D, Robert G. A descriptive study of first time outpatient public psychiatric care after 65 years. BMC Health Serv Res 2024; 24:1208. [PMID: 39385169 PMCID: PMC11462808 DOI: 10.1186/s12913-024-11680-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 09/30/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND Mental health in the older adults represents a public health issue, especially depression and suicide, and even more in the Brittany French region. Community Mental Health Centers (CMHC) are the front-line French psychiatric healthcare organizations, but the number, characteristics and trajectories of the older adults consulting there for the first time are unknown. METHOD An exhaustive cross-sectional study from medical records about first-time consultants in any CMHC of the Guillaume Régnier Hospital Center in 2019, and quantifying and describing the 65 and over ones according to socio-demographic, clinical, geographic and trajectory criteria. RESULTS This population represents 9.7% of all first consulting in CMHCs. We can note that 70.5% are female, 46.8% are living alone and 31.2% are widowed. These 3 rates are higher than in the general population. The main diagnosis we found is mood disorder (35.1%). Organic mental disorders are scarce (8.2%). Most people are referred by a general practitioner (53.4%) or a specialist/hospital center (23.7%). The main referral at the end is to CMHC care (73.6%). Only 20.0% had a referral to non-psychiatric health professionals (GP, coordination support teams, geriatrics, other professionals). Significant differences in the referral at the end exist between 65 and 74, who are more referred to CMHC professionals, and 75 and over, who are more frequently referred to non-psychiatric health professionals. Significant discrepancies about who referred are found according to community area-type. CONCLUSION These results align with the literature about known health-related characteristics and the importance of depression in the older people. They question the link with non-psychiatric professionals, and the need to structure a homogeneous care organization in psychiatric care for the older adults with trained professionals, especially for the 75 and over.
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Affiliation(s)
- Luc Daucé-Fleuret
- Centre Hospitalier Guillaume Régnier, Direction des Soins/Pôle G07-G08, Rennes, 35000, France.
| | - Astrid Reilhac
- Département d'Information Médicale, Centre Hospitalier Guillaume Régnier, Rennes, 35000, France
| | - Nathalie Alleton
- Unité de Recherche Clinique, Centre Hospitalier Guillaume Régnier, Rennes, 35000, France
| | - Dominique Somme
- Université de Rennes, CHU Rennes, CNRS, ARENES - UMR 6051, RSMS - U 1309, Rennes, F-35000, France
| | - Gabriel Robert
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, 35000, France
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Pasilan RM, Tomacruz-Amante ID, Dimacali CT. The epidemiology and microbiology of central venous catheter related bloodstream infections among hemodialysis patients in the Philippines: a retrospective cohort study. BMC Nephrol 2024; 25:331. [PMID: 39358687 PMCID: PMC11447977 DOI: 10.1186/s12882-024-03776-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/24/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Despite efforts to improve the management of catheter-related bloodstream infections (CRBSI) in literature, temporary CVCs continue to be used for maintenance hemodialysis outside of acute care settings, particularly in the Philippines. METHODS We conducted a retrospective cohort study to investigate the incidence, outcomes, risk factors, and microbiological patterns of CRBSI among adult kidney disease patients undergoing hemodialysis at the Philippine General Hospital, the country's largest tertiary referral center. We included all adult patients who received a CVC for hemodialysis from January 1, 2018, to August 31, 2019, and followed them for six months to observe the occurrence of CRBSI and its outcomes. RESULTS Our study documented a CRBSI incidence rate of 6.72 episodes per 1000 catheter days, with a relapse rate of 5.08%, a reinfection rate of 15.74%, and a mortality rate of 6.09%. On multivariable regression analysis, we identified autoimmune disease, dialysis frequency of > 3 × per week, use of CVC for either blood transfusion or IV medications, renal hypoperfusion, drug-induced nephropathy, and hypertensive kidney disease as significant risk factors for CRBSI. Gram-negative bacteria, including B. cepacia complex, Enterobacter, and Acinetobacter spp, were the most common organisms causing CRBSI. Multidrug-resistant organisms (MDROs) comprised almost half of the isolates (n = 89, 44.5%), with Coagulase-negative Staphylococcus species having the highest proportion among gram-positive organisms and Acinetobacter spp. among gram-negative isolates. CONCLUSION Our findings emphasize the need for more stringent measures and interventions to prevent the propagation of identified pathogens, such as a review of sterile technique and adequate hygiene practices, continued surveillance, and expedited placement and utilization of long-term access for patients on maintenance hemodialysis. Furthermore, CVC use outside of hemodialysis should be discouraged, and common antibiotic regimens such as piperacillin-tazobactam and fluoroquinolones should be reviewed for their low sensitivity patterns among gram-negative isolates. Addressing these issues can improve hemodialysis patients' outcomes and reduce the CRBSI burden in our institution.
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Affiliation(s)
- Renz Michael Pasilan
- Division of Nephrology, Department of Medicine, University of the Philippines - Philippine General Hospital, 6th Floor, Ermita, Manila, 1000, Philippines.
| | - Isabelle Dominique Tomacruz-Amante
- Division of Nephrology, Department of Medicine, University of the Philippines - Philippine General Hospital, 6th Floor, Ermita, Manila, 1000, Philippines
| | - Coralie Therese Dimacali
- Division of Nephrology, Department of Medicine, University of the Philippines - Philippine General Hospital, 6th Floor, Ermita, Manila, 1000, Philippines
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Hewitt J, Wilson M, Bonner A, Bloomer MJ. Factors That Influence Access to Medical Assistance in Dying Services: An Integrative Review. Health Expect 2024; 27:e70058. [PMID: 39415630 DOI: 10.1111/hex.70058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/18/2024] [Accepted: 09/24/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND In nearly all jurisdictions where it is permitted, Medical Assistance in Dying is situated in a healthcare system. Currently, limited evidence demonstrates how supply and demand factors influence access to Medical Assistance in Dying. OBJECTIVE The aim of this study is to synthesise empirical research from jurisdictions where Medical Assistance in Dying is legal to identify how supply and demand factors influence access for eligible adults. METHOD An integrative review was conducted. CINAHL Complete, PubMed, ProQuest, PsycINFO and Embase databases were systematically searched for studies published between January 1998 and January 2024. Records were independently assessed against inclusion and exclusion criteria. Additional studies were identified by forward and backward citation searching. All studies were assessed for quality. Findings were analysed deductively using an established conceptual framework, and a secondary narrative synthesis was undertaken. RESULTS Fifty-eight studies met the inclusion criteria. Most studies (n = 32) reported results related to the supply side, 16 reported on the demand side and 10 reported on both supply and demand dimensions of access. Studies about supply showed that health service policies may obstruct access to Medical Assistance in Dying. For healthcare professionals, the practice entails an additional workload and can create tensions with colleagues. Studies of the demand for Medical Assistance in Dying focused on supporting time-critical decisions, adequate planning and caregiver support. CONCLUSION Access to Medical Assistance in Dying requires the participation of health services and healthcare professionals but is hindered by policies that obstruct access and direct financial and indirect emotional labour costs. Innovative and inclusive models to promote high-quality, compassionate care at the end of life and access to Medical Assistance in Dying should be considered. PATIENT OR PUBLIC CONTRIBUTION Patients, caregivers and service users were involved in many of the studies included in this review, and their experiences and perspectives contributed to the analysis and synthesis in this review.
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Affiliation(s)
- Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Queen Elizabeth II Hospital, Metro South Health and Hospital Service, Coopers Plains, Queensland, Australia
- Law Futures Centre, Griffith University, Nathan, Queensland, Australia
| | - Michael Wilson
- University of Adelaide Nursing School, Adelaide, Australia
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Health and Hospital Service, Woolloongabba, Queensland, Australia
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Manyeneng LG, Pilusa ML. Experiences of occupational nurses regarding non-adherent mineworkers with chronic illnesses. Health SA 2024; 29:2783. [PMID: 39364197 PMCID: PMC11447645 DOI: 10.4102/hsag.v29i0.2783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 08/14/2024] [Indexed: 10/05/2024] Open
Abstract
Background Occupational nurses continue to provide service to mineworkers diagnosed with chronic illnesses, however, non-adherence to medication is prevalent, cause overcrowding, long queues and admission at hospitals as they become sick. Aim This study aimed to describe the experience of occupational nurses (ONs) regarding non-adherence to medication among mineworkers diagnosed with chronic illnesses. Setting The study was conducted at a selected mine in Gauteng province, South Africa. Methods A qualitative, exploratory, descriptive design that is contextual in nature, was used with a phenomenological approach. Thirteen ONs were purposively sampled and individual face-to-face interviews were conducted until data saturation was reached. Thematic analysis using ATLAS.ti 24 software was applied to analyse the data collected. The researcher and the independent coder held a consensus discussion and agreed on the themes and the sub-themes. Results Two themes and various sub-themes emerged along with Care-related challenges linked to the mineworkers and challenges related to the provision of service to mineworkers. Data analysed indicated that the ONs had varying but often similar perspectives regarding non-adherence to medication among mineworkers diagnosed with chronic illnesses. Conclusion Non-adherence to medication is prevalent among mineworkers diagnosed with chronic illnesses and improving the mineworkers' outcomes requires addressing the issue of non-adherence to primary medication. Contribution This study highlights the importance of adhering to prescribed medication among mineworkers diagnosed with chronic illnesses to ensure quality of life.
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Affiliation(s)
- Lorato G Manyeneng
- Department of Nursing Science, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Mogale L Pilusa
- Adelaide Tambo School of Nursing Science, Faculty of Science, Tshwane University of Technology, Pretoria, South Africa
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Sharma A, Deshmukh P, Jain S, Gaurkar SS, Sharma A. Factors Contributing to Postoperative Radiotherapy Delays in Head and Neck Cancer: A Comprehensive Review. Cureus 2024; 16:e67240. [PMID: 39301336 PMCID: PMC11412262 DOI: 10.7759/cureus.67240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 08/19/2024] [Indexed: 09/22/2024] Open
Abstract
Head and neck cancer encompasses a diverse group of malignancies that pose significant challenges in their management due to their heterogeneity in clinical behavior and treatment response. Postoperative radiotherapy (PORT) is a critical component in the treatment regimen for head and neck cancer, aimed at reducing local recurrence and improving overall survival (OS). However, delays in the initiation of PORT can significantly compromise patient outcomes. This comprehensive review explores the factors contributing to such delays, categorizing them into patient-related, treatment-related, and systemic factors. Patient-related factors include health status, comorbidities, socioeconomic barriers, and psychological issues. Treatment-related factors involve surgical complications, complexities in treatment planning, and coordination challenges between surgical and radiation oncology teams. Systemic and institutional factors encompass hospital resources, staffing levels, administrative and insurance issues, and geographic barriers. The review also examined the impact of these delays on patient outcomes, highlighting the increased risk of recurrence and reduced survival rates. Strategies to mitigate delays are discussed, including improved preoperative and postoperative planning, enhanced multidisciplinary coordination, patient education, and systemic policy changes. Additionally, case studies and real-world examples of successful interventions are presented. Future directions for research and policy recommendations are also outlined, emphasizing the need for continued efforts to ensure timely PORT for head and neck cancer patients. This review aims to provide a comprehensive analysis that can inform clinical practice and policy, ultimately improving the standard of care and patient outcomes in head and neck cancer treatment.
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Affiliation(s)
- Abhijeet Sharma
- Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad Deshmukh
- Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shraddha Jain
- Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sagar S Gaurkar
- Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ayushi Sharma
- Dental Sciences, People's College of Dental Science and Research Centre, Bhopal, IND
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Dhunnoo P, Kemp B, McGuigan K, Meskó B, O'Rourke V, McCann M. Evaluation of Telemedicine Consultations Using Health Outcomes and User Attitudes and Experiences: Scoping Review. J Med Internet Res 2024; 26:e53266. [PMID: 38980704 PMCID: PMC11267102 DOI: 10.2196/53266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/27/2024] [Accepted: 03/19/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Despite a recent rise in adoption, telemedicine consultations retention remains challenging, and aspects around the associated experiences and outcomes remain unclear. The need to further investigate these aspects was a motivating factor for conducting this scoping review. OBJECTIVE With a focus on synchronous telemedicine consultations between patients with nonmalignant chronic illnesses and health care professionals (HCPs), this scoping review aimed to gain insights into (1) the available evidence on telemedicine consultations to improve health outcomes for patients, (2) the associated behaviors and attitudes of patients and HCPs, and (3) how supplemental technology can assist in remote consultations. METHODS PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guided the scoping review process. Inclusion criteria were (1) involving adults with nonmalignant, noncommunicable chronic conditions as the study population; (2) focusing on health outcomes and experiences of and attitudes toward synchronous telemedicine consultations between patients and HCPs; and (3) conducting empirical research. A search strategy was applied to PubMed (including MEDLINE), CINAHL Complete, APA PsycNet, Web of Science, IEEE, and ACM Digital. Screening of articles and data extraction from included articles were performed in parallel and independently by 2 researchers, who corroborated their findings and resolved any conflicts. RESULTS Overall, 4167 unique articles were identified from the databases searched. Following multilayer filtration, 19 (0.46%) studies fulfilled the inclusion criteria for data extraction. They investigated 6 nonmalignant chronic conditions, namely chronic obstructive pulmonary disease, diabetes, chronic kidney disease, ulcerative colitis, hypertension, and congestive heart failure, and the telemedicine consultation modality varied in each case. Most observed positive health outcomes for patients with chronic conditions using telemedicine consultations. Patients generally favored the modality's convenience, but concerns were highlighted around cost, practical logistics, and thoroughness of clinical examinations. The majority of HCPs were also in favor of the technology, but a minority experienced reduced job satisfaction. Supplemental technological assistance was identified in relation to technical considerations, improved remote workflow, and training in remote care use. CONCLUSIONS For patients with noncommunicable chronic conditions, telemedicine consultations are generally associated with positive health outcomes that are either directly or indirectly related to their ailment, but sustained improvements remain unclear. These modalities also indicate the potential to empower such patients to better manage their condition. HCPs and patients tend to be satisfied with remote care experience, and most are receptive to the modality as an option. Assistance from supplemental technologies mostly resides in addressing technical issues, and additional modules could be integrated to address challenges relevant to patients and HCPs. However, positive outcomes and attitudes toward the modality might not apply to all cases, indicating that telemedicine consultations are more appropriate as options rather than replacements of in-person visits.
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Affiliation(s)
- Pranavsingh Dhunnoo
- Department of Computing, Atlantic Technological University, Letterkenny, Ireland
- The Medical Futurist Institute, Budapest, Hungary
| | - Bridie Kemp
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
| | - Karen McGuigan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
| | | | - Vicky O'Rourke
- Faculty of Business, Atlantic Technological University, Letterkenny, Ireland
| | - Michael McCann
- Department of Computing, Atlantic Technological University, Letterkenny, Ireland
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Jackson M, Ibrahim Y, Freeland C, Jacob S, Zovich B, Cohen C. Barriers to accessing hepatitis B medication: a qualitative study from the USA and Canada. BMJ Open 2024; 14:e080658. [PMID: 38772585 PMCID: PMC11110584 DOI: 10.1136/bmjopen-2023-080658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/29/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES To collect and document the numerous barriers that people living with hepatitis B (PLHB) encounter when trying to access their hepatitis B virus (HBV) medications. DESIGN Researchers collected qualitative data through 24 online interviews. The semistructured interview questions focused on the impact that HBV has on different aspects of daily life (physical, emotional and social), personal experiences managing their infection, HBV treatment experiences and interactions with healthcare providers. SETTING All interviews occurred over Zoom. PARTICIPANTS The participant cohort consisted of 12 males and 12 females. 63% of all participants represented communities of colour (37% white, 17% black/African/African American and 46% Asian/Asian American). Most of the participants were on antiviral treatment at the time of the study (62%). Participants were PLHB (self-reported), ≥18 years old, living in the USA or Canada and spoke English. RESULTS Participants reported several barriers to accessing medicine among PLHB including financial barriers, health insurance and pharmacy preauthorisation process and other intangible barriers like lack of access to reliable patient-friendly information and stigma. The identified barriers to accessing HBV medication impacted patients' continuity of care. CONCLUSIONS Access to medicine is essential to improving health outcomes. PLHB experience significant barriers to accessing HBV antivirals at different levels. Patient-related, physician-related and healthcare system barriers were identified as themes contributing to antiviral access challenges. More research is needed to identify strategies to improve access to HBV medications.
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Affiliation(s)
| | | | | | - Sophie Jacob
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | | | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
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Shimels T, Gashawbeza B, Fenta TG. Validation of the Amharic version of perceived access to healthcare services for patients with cervical cancer in Ethiopia: A second-order confirmatory factor analysis. PLoS One 2024; 19:e0300815. [PMID: 38748736 PMCID: PMC11095753 DOI: 10.1371/journal.pone.0300815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/05/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Accessing healthcare services is a multifaceted phenomenon involving various elements, encompassing the demand, identification, reach, and utilization of healthcare needs. The literature offers methods for capturing patients' perceptions of healthcare access. However, to accurately measure patient perceptions, it is imperative to ensure the validity and reliability of such instruments by designing and implementing localized language versions. AIM The primary aim of this study was to validate the Amharic version of the perceived access to health-care services among patients diagnosed with cervical cancer in Ethiopia. METHOD A cross-sectional study was conducted among cervical cancer patients at oncology centers in Addis Ababa, Ethiopia. A consecutive sampling approach was used and data collection took place from January 1 to March 30, 2023. Following initial validation and pretesting, a KoboCollect mobile phone application was employed for data collection. Subsequently, the collected data underwent cleaning in Microsoft Excel and analysis through Amos software v.26 and R programming. Various validity and reliability tests, such as content validity, convergent validity, face validity, divergent validity, known-group validity, and reliability tests, were executed. A second-order confirmatory factor analysis was developed to calculate incremental model fit indices, including CFI and TLI, along with absolute measures, namely SRMR and RMSEA. RESULTS A total of 308 participants were involved in the study, with 202 (65.6%) being patients referred from outside Addis Ababa. The initial evaluation of content validity by expert panels indicated that all criteria were met, with a CVR range of 0.5 to 1, I-CVI values ranging from 0.75 to 1, an S-CVI value of 0.91, and face validity values ranging from 2.4 to 4.8. The internal consistency of items within the final constructs varied from 0.76 to 0.93. Convergent, known-group, and most divergent validity tests fell within acceptable fit ranges. Common incremental fit measures for CFI and TLI were achieved with corresponding values of 0.95 and 0.94, respectively. The absolute fit measures of SRMR and RMSEA were 0.04 and 0.07, indicating good and moderate fit, respectively. CONCLUSION The study indicated a high internal consistency and validity of items with good fit to the data, suggesting potential accuracy of the domains. A five-domain structure was developed which enables adequate assessment of perceived access to health-care services of patients with cervical cancer in Ethiopia. We suggest that the tool can be utilized in other patient populations with a consideration of additional constructs, such as geographic accessibility.
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Affiliation(s)
- Tariku Shimels
- Research Directorate, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Department of Pharmaceutics & Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Biruck Gashawbeza
- Department of Gynecology & Obstetrics, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Teferi Gedif Fenta
- Department of Pharmaceutics & Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Jedamzik J, Kampling H, Christoffer A, Szardenings C, Heuft G, Friederich HC, Kruse J. Do the elderly and those with comorbid chronic physical conditions have improved access to outpatient psychotherapy post structural reforms in Germany? Results of the ES-RiP study. Front Psychiatry 2024; 15:1349603. [PMID: 38742126 PMCID: PMC11090099 DOI: 10.3389/fpsyt.2024.1349603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Background In 2017, a reform of the German outpatient psychotherapy guideline was carried out, aiming to reduce waiting times and facilitate low-threshold access. This study analyzes the extent to which the implementation of the two new service elements 'psychotherapeutic consultation times' and 'acute short-term psychotherapeutic interventions' improved psychotherapeutic care for patients with mental disorders and chronic physical conditions (cMPs), for patients with mental disorders without chronic physical conditions (MnoP), and elderly patients. Methods In a quantitative secondary analysis, we analyzed health insurance data of patients with psychotherapy billing codes obtained from the National Association of Statutory Health Insurance Physicians (KBV) for the years 2015-2019, evaluating descriptive statistical parameters for specific patient groups and care services. Results Between 2015 and 2019, the number of mentally ill receiving psychotherapy at least once in the corresponding year increased by 30.7%. Among these, the proportion of cMPs-patients increased from 26.8% to 28.2% (+1.4%), while that of MnoP-patients decreased from 68.3% to 66.4% (-1.9%). The number of elderly people receiving treatment also increased. Conclusion Since increases and decreases in the percentage shares occur evenly over the years investigated, it is questionable whether the reform in 2017 has had a direct influence on these changes. Study registration ID DRKS00020344, URL: https://www.bfarm.de/DE/Das-BfArM/Aufgaben/Deutsches-Register-Klinischer-Studien/_node.html.
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Affiliation(s)
- Johanna Jedamzik
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Andrea Christoffer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Carsten Szardenings
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Gereon Heuft
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
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Chua JYX, Kan EM, Lee PP, Shorey S. Application of the Stanford Biodesign Framework in Healthcare Innovation Training and Commercialization of Market Appropriate Products: A Scoping Review. J Med Syst 2024; 48:44. [PMID: 38647719 DOI: 10.1007/s10916-024-02067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
The Stanford Biodesign needs-centric framework can guide healthcare innovators to successfully adopt the 'Identify, Invent and Implement' framework and develop new healthcare innovations products to address patients' needs. This scoping review explored the application of the Stanford Biodesign framework for healthcare innovation training and the development of novel healthcare innovative products. Seven electronic databases were searched from their respective inception dates till April 2023: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest Dissertations, and Theses Global. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews and was guided by the Arksey and O'Malley's scoping review framework. Findings were analyzed using Braun and Clarke's thematic analysis framework. Three themes and eight subthemes were identified from the 26 included articles. The main themes are: (1) Making a mark on healthcare innovation, (2) Secrets behind success, and (3) The next steps. The Stanford Biodesign framework guided healthcare innovation teams to develop new medical products and achieve better patient health outcomes through the induction of training programs and the development of novel products. Training programs adopting the Stanford Biodesign approach were found to be successful in improving trainees' entrepreneurship, innovation, and leadership skills and should continue to be promoted. To aid innovators in commercializing their newly developed medical products, additional support such as securing funds for early start-up companies, involving clinicians and users in product testing and validation, and establishing new guidelines and protocols for the new healthcare products would be needed.
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Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Enci Mary Kan
- Singapore Biodesign, Agency for Science, Technology and Research, Singapore, Singapore
- Innovation & Entrepreneurship, Duke-NUS Medical School, Singapore, Singapore
| | - Phin Peng Lee
- Singapore Biodesign, Agency for Science, Technology and Research, Singapore, Singapore
- Innovation & Entrepreneurship, Duke-NUS Medical School, Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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Meulman I, Uiters E, Cloin M, Polder J, Stadhouders N. Systematic review of individual-level, community-level, and healthcare system-level factors contributing to socioeconomic differences in healthcare utilisation in OECD countries with universal health coverage. BMJ Open 2024; 14:e080559. [PMID: 38503421 PMCID: PMC10952876 DOI: 10.1136/bmjopen-2023-080559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Countries with universal health coverage (UHC) strive for equal access for equal needs without users getting into financial distress. However, differences in healthcare utilisation (HCU) between socioeconomic groups have been reported in countries with UHC. This systematic review provides an overview individual-level, community-level, and system-level factors contributing to socioeconomic status-related differences in HCU (SES differences in HCU). DESIGN Systematic review following the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. The review protocol was published in advance. DATA SOURCES Embase, PubMed, Web of Science, Scopus, Econlit, and PsycInfo were searched on 9 March 2021 and 9 November 2022. ELIGIBILITY CRITERIA Studies that quantified the contribution of one or more factors to SES difference in HCU in OECD countries with UHC. DATA EXTRACTION AND SYNTHESIS Studies were screened for eligibility by two independent reviewers. Data were extracted using a predeveloped data-extraction form. Risk of bias (ROB) was assessed using a tailored version of Hoy's ROB-tool. Findings were categorised according to level and a framework describing the pathway of HCU. RESULTS Of the 7172 articles screened, 314 were included in the review. 64% of the studies adjusted for differences in health needs between socioeconomic groups. The contribution of sex (53%), age (48%), financial situation (25%), and education (22%) to SES differences in HCU were studied most frequently. For most factors, mixed results were found regarding the direction of the contribution to SES differences in HCU. CONCLUSIONS SES differences in HCU extensively correlated to factors besides health needs, suggesting that equal access for equal needs is not consistently accomplished. The contribution of factors seemed highly context dependent as no unequivocal patterns were found of how they contributed to SES differences in HCU. Most studies examined the contribution of individual-level factors to SES differences in HCU, leaving the influence of healthcare system-level characteristics relatively unexplored.
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Affiliation(s)
- Iris Meulman
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Center for Public Health, Health Services and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ellen Uiters
- Center for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Mariëlle Cloin
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Johan Polder
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Center for Public Health, Health Services and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Niek Stadhouders
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Liashiedzi GK, Eto FE, Atinga RA, Abor PA. Determinants of mobile health (M-Health) application adoption, usage and discontinuity among corporate workers diagnosed with hypertension and diabetes. J Health Organ Manag 2024; ahead-of-print. [PMID: 38437500 DOI: 10.1108/jhom-11-2022-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
PURPOSE This study examined the determinants of mobile health (M-Health) application, adoption, usage and discontinuation among corporate workers diagnosed with hypertension and diabetes in Ghana. DESIGN/METHODOLOGY/APPROACH The diffusion innovation and reasoned action theories were employed using an exploratory design. Three hundred corporate workers diagnosed with diabetes and hypertension from three health facilities for the past six months were sampled for the study using a multi-stage sampling technique and administered questionnaires. Descriptive statistics and logistic regression tools were employed in the analysis of data. FINDINGS The study found a significant number of factors influencing m-health applications adoption, usage and discontinuity. These factors include nature and demand of job, perceived advantage, compatibility, complexity, triability, aesthetics and trust. Aesthetics emerged as the strongest predictive factor for the adoption, usage and discontinuity of use among diabetic and hypertensive corporate workers. With the adoption of M-Health applications, compatibility, as well as nature and demand of job, were significant predictors. With the usage of M-Health applications, complexity, triability, aesthetics and trust were significant predictors. Moreover, perceived advantage, compatibility, complexity and triability influenced significantly the choice to discontinue using M-Health applications. The study concluded that M-Health application functionalities play a valuable role in patients' intention to adopt, use and discontinue the use of an M-Health application in Ghana. ORIGINALITY/VALUE This exploratory study offers in-depth insight into how major M-Health application features affect its adoption, usage and discontinuity, providing crucial information for future research and the improvement of chronic condition healthcare delivery.
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Affiliation(s)
- Gabriel Kojovi Liashiedzi
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | - Florence Elorm Eto
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | - Roger Ayimbillah Atinga
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | - Patience Aseweh Abor
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
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Ejiohuo O, Onyeaka H, Unegbu KC, Chikezie OG, Odeyemi OA, Lawal A, Odeyemi OA. Nourishing the Mind: How Food Security Influences Mental Wellbeing. Nutrients 2024; 16:501. [PMID: 38398825 PMCID: PMC10893396 DOI: 10.3390/nu16040501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 01/25/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Food insecurity is a significant public health problem worldwide and critical to mental health. There is a complex relationship between food security and mental health. We carried out a narrative review study aiming to address how food insecurity impacts mental wellbeing by focusing on the mental health repercussions of food insecurity, recognizing its pivotal role in attaining Sustainable Development Goals 2 (on hunger) and 3 (on enhancing global wellbeing). A comprehensive search was conducted on PubMed and Google Scholar, incorporating Google searches for pertinent reports and policy documents. To address these questions, we emphasized and elucidated the interconnectedness between food security and mental health. The review shows that food security and mental health share a profound relationship influenced by multifaceted factors like socioeconomic conditions, access to nutritious food, and societal inequalities. We then provide recommendations for integrating food security into mental health strategies based on the insights and conclusions drawn. Strategies ranging from sustainable farming practices to urban agriculture initiatives and digital mental health services demonstrate avenues for enhancing food safety and mental wellbeing. This highlights the need for collaborative interdisciplinary efforts and systemic reforms to address these interconnected challenges.
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Affiliation(s)
- Ovinuchi Ejiohuo
- Department of Psychiatric Genetics, Poznan University of Medical Sciences, 60-806 Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, Bukowska 70, 60-812 Poznan, Poland
| | - Helen Onyeaka
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Kingsley C. Unegbu
- Department of Vegetable Crops, Poznan University of Life Sciences, 60-594 Poznan, Poland;
| | - Obinna G. Chikezie
- Department of Seed Science and Technology, Poznan University of Life Sciences, 62-081 Poznan, Poland;
| | - Omowale A. Odeyemi
- College of Nursing, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife 220005, Osun, Nigeria;
| | - Adebola Lawal
- Hospital Management Board, Government House and Protocol Clinic, Akure 340283, Ondo, Nigeria;
| | - Olumide A. Odeyemi
- Office of Research Services, Research Division, University of Tasmania, Hobart, TAS 7001, Australia;
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Njuguna C, Tola HH, Maina BN, Magambo KN, Phoebe N, Mgamb EA, Tibananuka E, Turyashemererwa FM, Rubangakene M, Richard K, Opong G, Richard S, Opesen C, Mateeba T, Muyingo E, George U, Namukose S, Woldemariam YT. Perceived barriers of access to health and nutrition services under drought and food insecurity emergency in north-east Uganda: a qualitative study. BMC Public Health 2024; 24:390. [PMID: 38321413 PMCID: PMC10848454 DOI: 10.1186/s12889-024-17830-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/20/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND In the face of drought and food insecurity emergency, evidence on access to health and nutrition services is important. Karamoja is one of the regions that have experienced extreme drought and food insecurity emergency in Uganda. As a part of the drought and food insecurity emergency response, World Health Organization (WHO) with Ministry of Health (MoH) has designed and implemented a qualitative study in 15 districts that have experienced drought and food insecurity emergency in north-east Uganda. Thus, we aimed to explore the barriers of access to health and nutrition services in drought and food insecurity emergency affected districts in north-east Uganda. METHODS We employed a descriptive qualitative study design. We interviewed 30 patients and 20 Village Health Teams (VHT) from 15 districts. We employed an in-depth interview with semi-structured questions to collect data until information saturation reached. We used thematic data analysis approach by ATLAS.ti version 7.5.1.8 software. RESULTS Of the 30 interviewed subjects, 15 were female, and the median age of the subjects was 29 years with interquartile range (IQR) of 23 to 37 years. Majority (68.8%) of subjects reported that access to health and nutrition services was harder to them. Four themes: sociocultural and economic; environmental; health system, and individual related factors were identified as the barriers of access to health and nutrition services. CONCLUSION The present study identified several modifiable barriers that hinder access to health and nutrition services in drought and food insecurity affected districts. Comprehensive interventions aimed at addressing sociocultural, economic, environmental, health system and subject related challenges are required to improve access to health and nutrition services in drought and food insecurity affected setups.
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Affiliation(s)
- Charles Njuguna
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda.
| | - Habteyes Hailu Tola
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Benson Ngugi Maina
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Kwikiriza Nicholas Magambo
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Nabunya Phoebe
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Elizabeth Adhiambo Mgamb
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Evelyne Tibananuka
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Florence M Turyashemererwa
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Moses Rubangakene
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Kisubika Richard
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - George Opong
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Ssekitoleko Richard
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Chris Opesen
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Tim Mateeba
- Ministry of Health of Uganda, Kampala, Uganda
| | | | | | | | - Yonas Tegegn Woldemariam
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
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Wang XQ, Yang CC, Sun XL. Integrated physical and mental management for China's elderly: insights from Long-gang District, Shenzhen. FRONTIERS IN AGING 2024; 5:1361098. [PMID: 38379538 PMCID: PMC10876994 DOI: 10.3389/fragi.2024.1361098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024]
Abstract
China is in a period of rapid population aging. The total population of the elderly aged 60 and above in mainland China was 264 million in 2020, and is the country with the largest elderly population in the world, which is home to 1/5 of the world's older people. The urgency of actively coping with the aging population has never been greater, and China has raised it to the height of national strategy. To this end, China has issued several plans and projects on aging work. Many of them include multiple overlapping components. The management of physical illness and mental illness in the elderly is over-differentiated and segmented. However, it is common for older adults with complex health problems. The body and mind are inherently integrated and interact with each other, and should not be separated. There is an urgent need for integrated healthcare services for the physical and mental health of the elderly population. The national basic public health services play an important role in early detection and awareness of health problems for the elderly in community health services. This paper introduces the elderly health management services, one of the national basic public health projects, and the psychological care project for the elderly in Shenzhen, Guangdong Province, China. Taking Long-gang District's exploration of the joint management of physical and mental health of the elderly as an example, this review discusses the difficulties of the elderly health work, and the feasibility of integrating the elderly mental health and physical health in medical care. We outlook to build an integrated platform for physical and mental health of the elderly in China. Focus on the needs of older population, strengthen community health services, build a integrative team, fully publicize and improve health literacy of the elderly, link up and down and work together, improve coordination between providers of medical care and social services. It is of great significance to construct a strong public health system for the elderly and promote the realization of the grand goal of Healthy China.
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Affiliation(s)
- Xun qiang Wang
- Longgang Center for Chroinc Disease Control, Shenzhen, China
| | - Ce ce Yang
- Longgang Center for Chroinc Disease Control, Shenzhen, China
| | - Xi ling Sun
- Shanghai Huangpu Mental Health Center, Shanghai, Shanghai, China
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Shih HJ, Xue H, Min H, Wojtusiak J, Chang J. Informing Patient-Provider Engagement for Shared Decision Making Through Mobile Health Applications. Patient Prefer Adherence 2023; 17:3489-3501. [PMID: 38146503 PMCID: PMC10749551 DOI: 10.2147/ppa.s438710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023] Open
Abstract
Objective The study utilized a cross-sectional dataset to identify demographic and health factors associated with patient utilization of mHealth applications for engaging with healthcare providers. The focus was on adults with chronic health conditions as the primary app user group. The goal was to reveal specific barriers and facilitators to app adoption among smartphone users, with the aim of highlighting opportunities for upgrades that promote patient empowerment as a prerequisite for shared decision-making (SDM). Methods Data from the Health Information National Trends Survey (HINTS 5, Cycle 4, 2020) with 3865 respondents (≥18 years old) stratified analyses and weighted logistic regression were used. Results The study found that individuals having a wellness app on a smartphone increased the likelihood (OR 2.68, CI: 2.02-3.56, p-value < 0.0001) of discussing health conditions with providers. Furthermore, individuals with multiple chronic health conditions were more likely (OR 1.93, CI 1.26-2.95, p-value < 0.01) to use apps to use mobile health applications to engage with healthcare providers. Other significant variables affecting app usage such as race, marital status, and educational level. Conclusion Due to difficulties obtaining in-person healthcare, the COVID-19 epidemic forced a swift deployment of mHealth technologies. Even in the absence of a crisis, mobile health applications continue to be crucial for improving patient-provider engagement and developing novel approaches to healthcare delivery. During the pandemic, people with numerous chronic diseases used apps to stay in touch with doctors and maintain their reliance on these platforms. Nonetheless, different smartphone users continue to use mHealth application in different ways. The findings revealing barriers in mHealth app adoption among certain patient subgroups suggest opportunities for developers, in collaboration with users and providers, to enhance inclusion and acceptability when upgrading mHealth application platforms.
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Affiliation(s)
- Huan-Ju Shih
- Department of Health and Human Services, George Mason University, Fairfax City, VA, USA
| | - Hong Xue
- Department of Health and Human Services, George Mason University, Fairfax City, VA, USA
| | - Hua Min
- Department of Health and Human Services, George Mason University, Fairfax City, VA, USA
| | - Janusz Wojtusiak
- Department of Health and Human Services, George Mason University, Fairfax City, VA, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA
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Drgac D, Himmelsbach R. Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria. BMC Health Serv Res 2023; 23:1253. [PMID: 37964276 PMCID: PMC10647116 DOI: 10.1186/s12913-023-10276-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Demographic change and the rise of diabetes mellitus are leading to a projected increase in the prevalence of chronic wounds. People suffering from chronic wounds experience significant losses in their health-related quality of life. Health systems struggle to meet the needs of these persons, even in high-income countries. This paper explores wound nurses' perspectives on their professional practice in Austria. They play a key role as they do much of the treatment work, contribute to advancing the field, and enable interprofessional coordination. Their perspectives enable insights into how a health system provides care for elderly and chronically ill people. METHODS We used the Constructivist Grounded Theory framework to analyse transcripts of 14 semi-structured qualitative interviews with nurses who work in different treatment settings. RESULTS We identified three themes. Firstly, the interviewees characterise working with patients as a balancing act between offering enough support to build a trustful relationship while protecting themselves against the overwhelming situation of caring for a chronically ill person. Secondly, the interviewees compensate for nonexistent care pathways by building informal networks with doctors, which requires delicate relationship work. Thirdly, the study participants must prove their competence in every new professional encounter. Their need for professional autonomy clashes with the traditional doctor-nurse hierarchy. Based on these insights, we propose a grounded theory that conceives of nursing practice in terms of 'acts of negotiations'. CONCLUSION Our results demonstrate that wound nurses in Austria operate in an institutional environment whose outdated imagination of the nursing role is at odds with the care demands that arise from a growing number of elderly and chronically ill people. We detailed the 'acts of negotiation' nurses deploy to compensate for this situation. We identify areas for policy intervention to strengthen the autonomy of wound nurses, including access to statutory health insurance billing.
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Affiliation(s)
- Deborah Drgac
- Department of Political Science, University of Vienna, Universitätsstraße 7/2, Vienna, 1010, Austria.
- Research Group Senescence and Healing of Wounds, Ludwig Boltzmann Gesellschaft, Donaueschingenstraße 13, Vienna, 1200, Austria.
| | - Raffael Himmelsbach
- Research Group Senescence and Healing of Wounds, Ludwig Boltzmann Gesellschaft, Donaueschingenstraße 13, Vienna, 1200, Austria
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Pogrebnoy D, Dennett AM, Simpson DB, MacDonald-Wicks L, Patterson AJ, English C. Effects of Using Websites on Physical Activity and Diet Quality for Adults Living With Chronic Health Conditions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e49357. [PMID: 37856187 PMCID: PMC10623240 DOI: 10.2196/49357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Adults with chronic health conditions need support to manage modifiable risk factors such as physical inactivity and poor diet. Disease-specific websites with health information on physical activity and diet quality may be effective in supporting adults in managing their chronic illnesses. OBJECTIVE The primary aim of this review was to determine whether using websites with health information can lead to improvements in physical activity levels or diet quality in adults with chronic health conditions. METHODS Randomized controlled trials evaluating the effectiveness of website use on levels of physical activity or diet quality in adults with chronic health conditions were included. MEDLINE, Embase, CINAHL, and the Physiotherapy Evidence Database were searched from the earliest available record until February 2023. Data for outcomes measuring physical activity levels; diet quality; and, where reported, self-efficacy and quality of life were independently extracted by 2 reviewers. The risk of bias was assessed using the Physiotherapy Evidence Database scale, and the overall certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Where values were presented as the same unit of measure, postintervention scores were pooled for meta-analysis to yield an overall mean difference (MD). A standardized MD (SMD) was calculated for the pooled data in which different units for the same outcome were used. Individual trial data were described in cases where the data of trials could not be pooled. RESULTS A total of 29 trials (N=6418 participants) across 8 different disease groups with intervention periods ranging from 4 weeks to 12 months were included in the analysis. There was moderate-certainty evidence that using websites with health information increased levels of moderate to vigorous physical activity (MD=39 min/wk, 95% CI 18.60-58.47), quality of life (SMD=0.36, 95% CI 0.12-0.59), and self-efficacy (SMD=0.26, 95% CI 0.05-0.48) and high-certainty evidence for reduction in processed meat consumption (MD=1.1 portions/wk, 95% CI 0.70-1.58) when compared with usual care. No differences were detected in other measures of diet quality. There was no increased benefit for website users who were offered additional support. CONCLUSIONS The use of websites for risk factor management has the potential to improve physical activity levels, quality of life, and self-efficacy as well as reduce processed meat consumption for adults living with chronic health conditions when compared with usual care. However, it remains unclear whether using websites leads to meaningful and long-lasting behavior change. TRIAL REGISTRATION PROSPERO CRD42021283168; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283168.
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Affiliation(s)
- Dina Pogrebnoy
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Department of Physiotherapy, Western Health, St Albans, Australia
| | - Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
- School of Allied Health, Human Services and Sport, Latrobe University, Melbourne, Australia
| | - Dawn B Simpson
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Food and Nutrition Program, Hunter Medical Institute, Newcastle, Australia
| | - Amanda J Patterson
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Food and Nutrition Program, Hunter Medical Institute, Newcastle, Australia
| | - Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, Australia
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Shannon B, Bowles KA, Williams C, Ravipati T, Deighton E, Andrew N. Does a Community Care programme reach a high health need population and high users of acute care hospital services in Melbourne, Australia? An observational cohort study. BMJ Open 2023; 13:e077195. [PMID: 37751947 PMCID: PMC10533720 DOI: 10.1136/bmjopen-2023-077195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE The Community Care programme is an initiative aimed at reducing hospitalisations and emergency department (ED) presentations among patients with complex needs. We aimed to describe the characteristics of the programme participants and identify factors associated with enrolment into the programme. DESIGN This observational cohort study was conducted using routinely collected data from the National Centre for Healthy Ageing data platform. SETTING The study was carried out at Peninsula Health, a health service provider serving a population in Melbourne, Victoria, Australia. PARTICIPANTS We included all adults with unplanned ED presentation or hospital admission to Peninsula Health between 1 November 2016 and 31 October 2017, the programme's first operational year. OUTCOME MEASURES Community Care programme enrolment was the primary outcome. Participants' demographics, health factors and enrolment influences were analysed using a staged multivariable logistic regression. RESULTS We included 47 148 adults, of these, 914 were enrolled in the Community Care programme. Participants were older (median 66 vs 51 years), less likely to have a partner (34% vs 57%) and had more frequent hospitalisations and ED visits. In the multivariable analysis, factors most strongly associated with enrolment included not having a partner (adjusted OR (aOR) 1.83, 95% CI 1.57 to 2.12), increasing age (aOR 1.01, 95% CI 1.01 to 1.02), frequent hospitalisations (aOR 7.32, 95% CI 5.78 to 9.24), frequent ED visits (aOR 2.0, 95% CI 1.37 to 2.85) and having chronic diseases, such as chronic pulmonary disease (aOR 2.48, 95% CI 2.06 to 2.98), obesity (aOR 2.06, 95% CI 1.39 to 2.99) and diabetes mellitus (complicated) (aOR 1.75, 95% CI 1.44 to 2.13). Residing in aged care home and having high socioeconomic status) independently associated with reduced odds of enrolment. CONCLUSIONS The Community Care programme targets patients with high-readmission risks under-representation of individuals residing in residential aged care homes warrants further investigation. This study aids service planning and offers valuable feedback to clinicians about programme beneficiaries.
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Affiliation(s)
- Brendan Shannon
- Department of Paramedicine, Monash University, Franskton, Victoria, Australia
| | - Kelly-Ann Bowles
- Department of Paramedicine, Monash University, Franskton, Victoria, Australia
| | - Cylie Williams
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Tanya Ravipati
- Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, Victoria, Australia
| | - Elise Deighton
- Community Care, Peninsula Health, Frankston, Victoria, Australia
| | - Nadine Andrew
- Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, Victoria, Australia
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Fall Risk in Adult Family Practice Non-Attenders: A Cross-Sectional Study from Slovenia. Zdr Varst 2023. [DOI: 10.2478/sjph-2023-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
ABSTRACT
Introduction
Not much is known about the fall risk among the adult population of those who rarely visit doctors. We wanted to determine the prevalence of increased fall risk in a population of family practice non-attenders and the factors associated with it.
Methods
We included participants from family medicine practices in this cross-sectional study. To be included in the study, the participants had to be adults living in the community (home-dwelling people) who had not visited their chosen family physician in the last five years (non-attenders). The identification of the eligible persons was done through a search of electronic medical records, which yield 2,025 non-attenders. Community nurses collected data in the participants’ homes. The outcome measure was increased fall risk as assessed by the Morse fall scale: increased risk (≥25) vs. no risk.
Results
The sample consisted of 1,945 patients (96.0% response rate) with a mean age of 60.4 years (range 20.5 to 99.7 years). An increased fall risk was determined in 482 or 24.8% (95% CI: [22.9, 26.8]) of the patients. The multivariate model showed a significant association of increased fall risk with higher age (p<0.001), lower systolic blood pressure (p=0.047), poor family function (p=0.016), increased risk of malnutrition (p=0.013), higher number of chronic diseases (p=0.027), higher pain intensity (p<0.001), lower self-assessment of current health (p=0.002), and higher dependence in daily activities (p<0.001).
Conclusion
Non-attenders may have an increased risk of falling which depends on their health status and age. The inclusion of community nurses in primary healthcare teams could be of use not only to identify the non-attenders’ health needs, but also to better manage their health, especially the factors that were identified to be associated with greater fall risk.
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Faiçal AVB, Mota LR, Correia DDA, Monteiro LP, de Souza EL, Terse-Ramos R. Telehealth for children and adolescents with chronic pulmonary disease: systematic review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2024111. [PMID: 37194911 PMCID: PMC10185001 DOI: 10.1590/1984-0462/2024/42/2022111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/07/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To revise the impact of telehealth on the quality of life, reduction in pulmonary exacerbations, number of days using antibiotics, adherence to treatment, pulmonary function, emergency visits, hospitalizations, and the nutritional status of individuals with asthma and cystic fibrosis. DATA SOURCE Four databases were used, MEDLINE, LILACS, Web of Science and Cochrane, as well as manual searches in English, Portuguese and Spanish. Randomized clinical trials, published between January 2010 and December 2020, with participants aged 0 to 20 years, were included. DATA SYNTHESIS Seventy-one records were identified after the removal of duplicates; however, twelve trials were eligible for synthesis. Included trials utilized: mobile phone applications (n=5), web platforms (n= 4), mobile telemedicine unit (n=1), software with an electronic record (n=1), remote spirometer (n=1), and active video games platform (n=1). Three trials used two tools, including telephone calls. Among the different types of interventions, improvement in adherence, quality of life, and physiologic variables were observed for mobile application interventions and game platforms compared to usual care. Visits to the emergency department, unscheduled medical appointments, and hospitalizations were not reduced. There was considerable heterogeneity among studies. CONCLUSIONS The findings suggest that better control of symptoms, quality of life, and adherence to treatment can be attributed to the technological interventions used. Nevertheless, further research is needed to compare telehealth with face-to-face care and to indicate the most effective tools in the routine care of children with chronic lung diseases.
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Griese L, Finbråten HS, Francisco R, De Gani SM, Griebler R, Guttersrud Ø, Jaks R, Le C, Link T, Silva da Costa A, Telo de Arriaga M, Touzani R, Vrdelja M, Pelikan JM, Schaeffer D. HLS 19-NAV-Validation of a New Instrument Measuring Navigational Health Literacy in Eight European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13863. [PMID: 36360755 PMCID: PMC9654211 DOI: 10.3390/ijerph192113863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
To manoeuvre a complex and fragmented health care system, people need sufficient navigational health literacy (NAV-HL). The objective of this study was to validate the HLS19-NAV measurement scale applied in the European Health Literacy Population Survey 2019-2021 (HLS19). From December 2019 to January 2021, data on NAV-HL was collected in eight European countries. The HLS19-NAV was translated into seven languages and successfully applied in and validated for eight countries, where language and survey method differed. The psychometric properties of the scale were assessed using confirmatory factor analysis (CFA) and Rasch modelling. The tested CFA models sufficiently well described the observed correlation structures. In most countries, the NAV-HL data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). For some countries, some items showed poor data-model fit when tested against the PCM, and some items displayed differential item functioning for selected person factors. The HLS19-NAV demonstrated high internal consistency. To ensure content validity, the HLS19-NAV was developed based on a conceptual framework. As an estimate of discriminant validity, the Pearson correlations between the NAV-HL and general health literacy (GEN-HL) scales were computed. Concurrent predictive validity was estimated by testing whether the HLS19-NAV, like general HL measures, follows a social gradient and whether it forms a predictor of general health status as a health-related outcome of general HL. In some countries, adjustments at the item level may be beneficial.
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Affiliation(s)
- Lennert Griese
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Hanne S. Finbråten
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, 2418 Elverum, Norway
| | - Rita Francisco
- Católica Research Centre for Psychological, Family and Social Well-Being, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Saskia M. De Gani
- Careum Foundation, Careum Center for Health Literacy, 8032 Zurich, Switzerland
- Careum School of Health, Kalaidos University of Applied Sciences, 8006 Zurich, Switzerland
| | - Robert Griebler
- Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Øystein Guttersrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Rebecca Jaks
- Careum Foundation, Careum Center for Health Literacy, 8032 Zurich, Switzerland
| | - Christopher Le
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, 2418 Elverum, Norway
- Department of Social Determinants of Health, Division of Prevention and Public Health, Norwegian Directorate of Health, 0213 Oslo, Norway
| | - Thomas Link
- Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Andreia Silva da Costa
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1049-005 Lisboa, Portugal
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisboa, Portugal
| | - Miguel Telo de Arriaga
- Católica Research Centre for Psychological, Family and Social Well-Being, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
- Direção-Geral da Saúde, 1049-005 Lisboa, Portugal
| | - Rajae Touzani
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue 2019, 13009 Marseille, France
- Institut Paoli-Calmettes, SESSTIM U1252, 13009 Marseille, France
| | - Mitja Vrdelja
- Communication Unit, National Institute of Public Health, 1000 Ljubljana, Slovenia
| | - Jürgen M. Pelikan
- WHO-CC Health Promotion in Hospitals and Health Care, Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Doris Schaeffer
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
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23
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Schmidt AE, Rodrigues R, Simmons C, Steiber N. A crisis like no other? Unmet needs in healthcare during the first wave of the COVID-19 crisis in Austria. Eur J Public Health 2022; 32:969-975. [PMID: 36219785 PMCID: PMC9619656 DOI: 10.1093/eurpub/ckac136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Many patients experienced restricted access to healthcare during the Coronavirus Disease 2019 (COVID-19) pandemic. This study is among the first to provide systematic evidence on the existence of subjective unmet needs (SUN) in different population groups during the pandemic. Methods Using data on individuals aged 20–64 and living in Austria from the AKCOVID survey (June 2020) and the ‘European Social Survey’ (2015), SUN were compared between 2015 and 2020, either related to the pandemic (fear of infection, provider closed or treatment postponed) or not (barriers related to knowledge, affordability, time and reachability). Multinomial logistic regression models identified determinants of SUN during the pandemic, adjusting for socio-demographics, socio-economic status and self-reported health. Results Shares of the population with SUN in 2020 substantially exceeded SUN in 2015. Excess unmet needs were mostly attributable to the pandemic. Postponed treatments and closed providers were the most important reasons for SUN in June 2020. Older age groups (50–64 years), inactive and retired people were most likely to report pandemic-related SUN. We did not find socio-economic differences in pandemic-related SUN. Conclusions The pandemic resulted in a supply-side shock to healthcare, with vulnerabilities emerging especially among older people, people with poor health and/or people no longer active on the labour market. Further research could focus on health system resilience and the possibilities to improve management of healthcare services during pandemics without widening inequalities while maintaining population health.
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Affiliation(s)
- Andrea E Schmidt
- Austrian National Public Health Institute, Competence Centre on Climate and Health, Vienna, Austria
| | - Ricardo Rodrigues
- ISEG Lisbon School of Economics and Management, University of Lisbon, Lisbon, Portugal
| | - Cassandra Simmons
- Health and Care, European Centre for Social Welfare Policy and Research, Vienna, Austria
| | - Nadia Steiber
- Department of Sociology, University of Vienna, Vienna, Austria.,Institute for Advanced Studies, Vienna, Austria
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