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Sayegh CS, Carrera Diaz K, Smith J, Chang N, Chao LC. Qualitative Study Guiding the Design of a Person-Centered Shared Medical Appointment Model to Optimize Diabetes Care Delivery. Sci Diabetes Self Manag Care 2024; 50:287-297. [PMID: 38903019 DOI: 10.1177/26350106241258999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
PURPOSE The purpose of the study was to explore the shared medical appointment model (SMA) with youth with type 2 diabetes (T2DM) and their caregivers to identify health education needs, access barriers, and recommendations for intervention design. METHODS Patient and caregiver focus group interviews were conducted in English and Spanish to address these objectives: (1) identify barriers to participation in group sessions, (2) identify barriers to diabetes self-management, and (3) prioritize preference for SMA themes. Qualitative analysis identified strategies for patient recruitment and engagement and recommendations for curriculum design of a future SMA model for youth with T2DM. RESULTS Both adolescents and caregivers supported the development of an SMA model. Adolescents expressed concerns of initial discomfort and nervousness, whereas young adults described stigma as the main barrier to joining a group. Patients emphasized the importance of prioritizing youth comfort and families' convenience. Early adolescents and young adults preferred autonomy in the choice to join a group, whereas mid adolescents and caregivers preferred that the caregivers make that decision. Participants recommended nine topics regarding barriers to diabetes care. The topics that received the most enthusiasm were nutrition, exercise, navigating peer interactions, and stress management. CONCLUSIONS Youth with T2DM and their caregivers perceived many benefits of an SMA model and provided feedback to guide the development of a health education curriculum that could be integrated into an SMA clinic.
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Affiliation(s)
- Caitlin S Sayegh
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Kenia Carrera Diaz
- Psychology Postdoctoral Fellowship, Children's Hospital Los Angeles, Los Angeles, California
| | - Josephine Smith
- Division of Endocrinology, Children's Hospital Los Angeles, Los Angeles, California
| | - Nancy Chang
- Division of Endocrinology, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Lily C Chao
- Division of Endocrinology, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California
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Heidenreiter S, Lauerer M, Nagel E. [Unmet health care needs of younger and older people in socially deprived regions: A qualitative interview study in the Ruhr area]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 188:87-94. [PMID: 39019708 DOI: 10.1016/j.zefq.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Unmet health care needs are considered a key indicator of equity in access to health care. For younger people, they can lead to poorer health outcomes in adulthood, for older people, they are associated with an increased risk of mortality. Unmet needs were therefore investigated as part of a research project on "Improving the health-related life situation of young and old people in the Ruhr area." METHOD Unmet health care needs were surveyed with the help of semi-structured guideline interviews with younger and older people in the Ruhr area (n=29). Due to the spatial and social structure of the study region, the aim was to recruit especially people with a low subjective social status (SSS) for the study. The interviews were recorded, transcribed, and subjected to a qualitative content analysis and a supplementary frequency analysis. The reporting is based on the Standards for Qualitative Research (SRQR). RESULTS The respondents reported deficiencies in treatment and doctor-patient communication with GPs and specialists. The feeling of not being taken seriously due to age is cited several times by both age groups as a reason for unmet health care needs. Waiting times are particularly relevant in the case of specialist consultations, while co-payments for services mainly play a role in dentistry and orthodontics. Unmet needs are primarily reported by people with a medium SSS. Overall, almost two thirds of the respondents stated that they have or have had at least one unmet need. Participants with a low SSS report fewer unmet needs and do not mention any financial aspects as a cause. Explanations for this range from lower health literacy to the fear of being discredited. CONCLUSIONS The results provide indications of deficits in regional health care provision for younger and older people in the Ruhr region. Corresponding fields of action result from the areas of care and reasons identified as relevant for unmet health care needs. The reported findings also provide a basis for differentiated quantitative surveys with representative samples.
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Affiliation(s)
- Sarah Heidenreiter
- Institut für Medizinmanagement und Gesundheitswissenschaften (IMG) der Universität Bayreuth, Bayreuth, Deutschland.
| | - Michael Lauerer
- Institut für Medizinmanagement und Gesundheitswissenschaften (IMG) der Universität Bayreuth, Bayreuth, Deutschland
| | - Eckhard Nagel
- Institut für Medizinmanagement und Gesundheitswissenschaften (IMG) der Universität Bayreuth, Bayreuth, Deutschland
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Uwumiro F, Okpujie V, Ajiboye A, Abesin O, Ogunfuwa O, Mojeed O, Borowa A, Alemenzohu H, Hassan J, Ajayi O. Association between Insurance Status and Outcomes of Hospitalizations for Necrotizing Soft Tissue Infections. Surg Infect (Larchmt) 2024; 25:459-469. [PMID: 38985696 DOI: 10.1089/sur.2023.379] [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: 07/12/2024] Open
Abstract
Background: Lack of insurance is associated with poorer outcomes in hospitalized patients. However, few studies have explored this association in hospitalizations for necrotizing soft tissue infections (NSTIs). This study examined the impact of insurance status on the outcome of NSTI admissions. Methods: All adult hospitalizations for necrotizing fasciitis, gas gangrene, and Fournier gangrene between 2016 and 2018 were examined using the Nationwide Inpatient Sample database. Insurance status was categorized as insured (including Medicare, Medicaid, and Private, including Health maintenance organization (HMO) or uninsured (Self-pay). Outcome measures included mortality rates, limb loss, length of hospital stay, prolonged hospital stay, and critical care admissions. Statistical analysis included weighted sample analysis, chi-square tests, multivariate regression analysis, and negative binomial regression modeling. Results: Approximately 29,705 adult hospitalizations for NSTIs were analyzed. Of these, 57.4% (17,065) were due to necrotizing fasciitis, 22% (6,545) to gas gangrene, and 20.5% (6,095) to Fournier gangrene. Approximately 9.7% (2,875) were uninsured, whereas 70% (26,780) had insurance coverage. Among the insured, Medicare covered 39.6% (10,605), Medicaid 29% (7,775), and private insurance 31.4% (8,400). After adjustments, Medicare insurance was associated with greater odds of mortality (adjusted odds ratio [aOR]: 1.81; 95% confidence interval [CI]: 1.33-2.47; p = 0.001). Medicaid insurance was associated with increased odds of amputation (aOR: 1.81; 95% CI: 1.33-2.47; p < 0.001), whereas private insurance was associated with lower odds of amputation (aOR: 0.70; 95% CI: 0.51-0.97; p = 0.030). Medicaid insurance was associated with greater odds of prolonged hospital stay (aOR: 1.34; 95% CI: 1.09-1.64; p < 0.001). No significant association was observed between the lack of insurance or self-pay and the odds of primary or secondary outcomes. Conclusion: Medicare insurance was correlated with greater odds of mortality, whereas Medicaid insurance was associated with increased odds of amputation and longer hospital stay. Uninsured status was not associated with significant differences in NSTI outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Azabi Borowa
- College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Judith Hassan
- Department of Health Sciences and Social Work, Western Illinois University, Macomb, Illinois, USA
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Leach MJ, Veziari Y, Flanagan C, Schloss J. Prevalence of Complementary Medicine Use in Children and Adolescents: A Systematic Review. J Pediatr Health Care 2024; 38:505-519. [PMID: 38260926 DOI: 10.1016/j.pedhc.2023.12.010] [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: 09/29/2023] [Revised: 10/16/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION The objective of this systematic review was to determine the global prevalence of complementary medicine (CM) use among children and adolescents. METHOD Seven databases and the reference lists of included studies were searched for pertinent observational studies. Studies were limited to those published in English from July 1, 2013. Included studies were appraised using the JBI checklist for prevalence studies. RESULTS Twenty studies were eligible for inclusion (385,527 participants). Most studies were assessed as having low risk of bias. Meta-analyses revealed a 23.0% (95% confidence interval, 0.226-0.234; 17 studies) short-term (≤ 12 month) prevalence and a 77.7% (95% confidence interval, 0.760-0.794; six studies) lifetime prevalence of CM use in children and adolescents. Differences in CM use were evident across countries and regions. DISCUSSION The findings of this review indicate that the use of CM in children and adolescents is high and widespread and may be increasing.
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Ault AK, Comer-HaGans D, Faubert SJ, Wallace BA, Weller BE. Reasons for Unmet Health Care Needs Among Black, Hispanic, and White Children in the United States With or at Risk for Physical and Mental Health Conditions. Clin Pediatr (Phila) 2024:99228241263042. [PMID: 38912591 DOI: 10.1177/00099228241263042] [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] [Indexed: 06/25/2024]
Abstract
Children with special health care needs (CSHCN)-ie, children who are at increased risk for, or currently manage, persistent physical and mental health conditions-require more health care resources than children without special health care needs. Furthermore, CSHCN who identify as racial/ethnic minorities disproportionately encounter unmet needs, according to reports from their caregivers. However, the reasons for their unmet needs are relatively unknown. This study estimated and compared the US national prevalence of caregiver-reported reasons for unmet health care needs for Hispanic, non-Hispanic black, and non-Hispanic white CSHCN. The most common reasons were problems getting an appointment for black CSHCN and cost for Hispanic and white CSHCN. Issues related to transportation were significantly less likely for black than for white and Hispanic CSHCN. Cost-related issues were significantly less likely for black than Hispanic CSHCN. To address reasons for unmet needs for CSHCN, effective structural changes are needed.
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Campisi C, Pham D, Rapoport E, Adesman A. Parenting Stress, Community Support, and Unmet Health Care Needs of Children in the US. Matern Child Health J 2024; 28:1010-1019. [PMID: 38353888 DOI: 10.1007/s10995-024-03912-8] [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] [Accepted: 11/02/2023] [Indexed: 05/01/2024]
Abstract
OBJECTIVES In 2018, approximately 2.3 million children in the United States had unmet healthcare needs (UHCN). To date, studies examining associations between UHCN and parent stress and support have had limited generalizability. This study aimed to investigate the relationship between children's UHCN and parenting stress and support using a nationally representative sample. Additionally, this study aimed to assess associations between unmet mental health needs and these parental well-being measures. METHODS Households with children ages 0-17 and complete data on UHCN in the combined 2016, 2017, 2018, and 2019 cohorts of the National Survey of Children's Health (NSCH) met inclusion criteria. Logistic regressions were used to evaluate associations between overall UHCN and outcome measures of parental coping, aggravation, emotional support, and neighborhood support. Associations between mental UHCN and these outcome measures were analyzed in a subset limited to children with mental health conditions. Regressions were adjusted for potential confounders, including demographics, household income, medical home status, and health insurance (adequacy/type). RESULTS In our sample of 131,299 children, overall UHCN were associated with poorer parental coping (aOR = 5.35, 95% CI: [3.60, 7.95]), greater parental aggravation (aOR = 3.35, 95% CI: [2.73, 4.12]), and non-supportive neighborhood (aOR = 2.22, 95% CI: [1.86, 2.65]). Mental UHCN were similarly associated with parental coping and aggravation and neighborhood support in the mental health subset. CONCLUSIONS FOR PRACTICE Healthcare professionals must address the needs of children with UHCN and collaborate with community organizations and child advocates to promote coordinated and comprehensive care and adequately support caregivers.
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Affiliation(s)
- Christine Campisi
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Duy Pham
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Eli Rapoport
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA
- Department of Urology, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Andrew Adesman
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Division of Developmental and Behavioral Pediatrics, 1983 Marcus Avenue, Lake Success, NY, USA.
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Herlitz L, Ashford E, Powell C, Herbert K, Morris S, Woodman J. Access to primary care for children and young people (CYP) in the UK: a scoping review of CYP's, caregivers' and healthcare professionals' views and experiences of facilitators and barriers. BMJ Open 2024; 14:e081620. [PMID: 38816045 PMCID: PMC11141190 DOI: 10.1136/bmjopen-2023-081620] [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: 11/02/2023] [Accepted: 03/19/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVES To examine children and young people's (CYP), caregivers' and healthcare professionals' (HCPs) views or experiences of facilitators and barriers to CYP access to UK primary care services to better understand healthcare inequity. To explore differences across CYP subpopulations with greater health needs from deprived areas, identifying as ethnic minorities, with experiences of state care, special educational needs or disabilities, chronic conditions or mental health problems. DESIGN Scoping review. ELIGIBILITY CRITERIA Included studies were in English, published 2012-2022 and reported: the views/experiences of CYP (0-25 years), caregivers or HCPs about accessing UK primary care; using quantitative or qualitative empirical methods. DATA SOURCES PubMed, CINAHL, Web of Science, PsycINFO and Scopus. RESULTS We included 47 reports (46 studies). CYP/caregivers' decision to access care was facilitated by CYP/caregivers' or their family/friends' ability to identify a health issue as warranting healthcare attention. Barriers to accessing care included perceived stigma (eg, being seen as a bad parent), embarrassment and discrimination experiences. CYP and caregivers believed longer opening hours could facilitate more timely access to care. Caregivers and HCPs reported that delayed or rejected referrals to secondary or adult care were a barrier to having needs met, especially for CYP with poor mental health. CYP and caregivers in numerous studies emphasised the importance of communication and trust with HCPs, including taking their concerns seriously, being knowledgeable and providing continuity of care for CYP. Common barriers reported across high-need subpopulations were caregivers needing knowledge and confidence to advocate for their child, gaps in HCP's knowledge and a lack of connectedness between primary and secondary care. CONCLUSIONS Connecting general practices and community health workers/services, improving CYP/caregivers' understanding of common childhood conditions, addressing HCP's knowledge gaps in paediatric care and integrated approaches between primary and secondary care may reduce inequity in access.
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Affiliation(s)
- Lauren Herlitz
- NIHR Children and Families Policy Research Unit, Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
| | - Emily Ashford
- Thomas Coram Research Unit, UCL Social Research Institute, London, UK
| | - Claire Powell
- NIHR Children and Families Policy Research Unit, Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
| | - Kevin Herbert
- Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Morris
- Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Jenny Woodman
- Thomas Coram Research Unit, UCL Social Research Institute, London, UK
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van Klaveren LM, Geukers V, de Vos R. Care complexity, perceptions of complexity and preferences for interprofessional collaboration: an analysis of relationships and social networks in paediatrics. BMC MEDICAL EDUCATION 2024; 24:334. [PMID: 38528513 DOI: 10.1186/s12909-024-05304-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND In the context of increasingly intricate healthcare systems, professionals are compelled to collaborate within dynamically changing interprofessional teams. Moreover, they must adapt these collaborative processes to effectively and efficiently manage the evolving complexity of care needs. It remains unclear how professionals determine care complexity and relate this complexity to their preferences for interprofessional collaboration (IPC). This study investigated the relationships between care complexity, professionals' perceived complexity and IPC preferences, and examined the variation in individual and team characteristics of IPC-practices across different levels of complexity in paediatric care. METHODS In an online questionnaire, 123 healthcare professionals working at an academic tertiary children's hospital scored their perceptions of complexity and preferences for IPC. They also selected family and various professions as members of the interprofessional (IP-) team based on thirteen patient cases. We employed conjoint analysis to systematically model the complexity of case descriptions across the five domains of the International Classification of Functioning, Disability and Health (ICF). Additionally, we applied social network analysis to identify important professions, crucial connectors and influential professions in the IP-team, and to describe the cohesiveness of IP-teams. RESULTS Modelled case complexity, professionals' perceived complexity and IPC preferences were positively associated. We found large inter-individual variations in the degree of these associations. Social network analysis revealed that the importance and influence of professions was more equally distributed when case complexity increased. Depending on the context and complexity of the case, different professions (e.g. medical doctors, social professionals, extramural professionals) were considered to be more crucial connectors within the IP-team. Furthermore, team cohesion was positively associated with modelled and perceived care complexity. CONCLUSIONS In conclusion, our study contributes to the existing knowledge by integrating task-specific insights and broadening the use of conjoint and social network analysis in the context of IPC. The findings substantiate the contingency theory that relates characteristics of IPC to care complexity, offering quantified insights into how IP-teams adapt to situational needs. This understanding of relationships and variations within IPC holds crucial implications for designing targeted interventions in both clinical and health profession education contexts. Consequently, it contributes to advancements in healthcare systems.
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Affiliation(s)
- Lisa-Maria van Klaveren
- Institute for Education and Training, Amsterdam Universities Medical Centres location University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands.
| | - Vincent Geukers
- Emma Children's Hospital, Amsterdam Universities Medical Centres location University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Rien de Vos
- Institute for Education and Training, Amsterdam Universities Medical Centres location University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
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Jiang K, Zhang L, Xie C, Li Z, Shi Z, Sharma M, Zhao Y. Understanding the Knowledge, Attitudes, and Practices of Healthy Eating among Adolescents in Chongqing, China: An Empirical Study Utilizing Structural Equation Modeling. Nutrients 2024; 16:167. [PMID: 38201997 PMCID: PMC10780587 DOI: 10.3390/nu16010167] [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: 11/07/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Healthy eating is crucial for optimal growth, development, and the prevention of chronic diseases in adolescents. Our study aimed to develop a comprehensive structural equation model (SEM) to analyze the relationships between knowledge, attitudes, practices (KAP), and healthy eating among adolescents in Chongqing. An online questionnaire was administered to middle school students in 39 districts and counties of Chongqing, China from 2 December to 15 December 2021 to collect sociodemographic and KAP information. SEM models were constructed to examine the relationships between educational environment and healthy eating knowledge, attitudes, and practices. The Monte Carlo test was employed to assess the significance of the mediating effect of relevant variables. The study included 139,832 adolescents aged 14.8 ± 0.7 years, with a 14% rate of overweight and obesity. Health and nutrition knowledge averaged a score of 3.60 ± 1.50 (correct rate: 60%). Participants had positive attitudes (average score: 13.61 ± 2.29) and engaged in healthy eating practices (average score: 12.06 ± 3.08). The results of the SEM revealed a significant influence of the educational environment on adolescents' knowledge (β = 0.235, p < 0.001) and attitude towards healthy eating (β = 0.143, p < 0.001). Knowledge exhibited positive effects on both attitude (β = 0.225, p < 0.001) and practice (β = 0.054, p < 0.001), while attitude exhibited positive effects on practice behavior (β = 0.565, p < 0.001). The indirect effect of knowledge on practices through attitude was more substantial than the direct effect (ratio 2.361). Our study highlights the mediating role of attitude between healthy eating knowledge and practices. A significant association exists between a favorable educational environment and improved knowledge and positive attitudes toward healthy eating among adolescents. In the future, nutrition and health education should prioritize exploring effective ways to translate knowledge into practices.
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Affiliation(s)
- Ke Jiang
- School of Public Health, Chongqing Medical University, Chongqing 400331, China; (K.J.); (L.Z.); (Z.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
| | - Laixi Zhang
- School of Public Health, Chongqing Medical University, Chongqing 400331, China; (K.J.); (L.Z.); (Z.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
| | - Changxiao Xie
- Department of Nutrition and Food Hygiene, West China School of Public Health, Sichuan University, Chengdu 610041, China;
| | - Zhourong Li
- School of Public Health, Chongqing Medical University, Chongqing 400331, China; (K.J.); (L.Z.); (Z.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Manoj Sharma
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA;
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA
| | - Yong Zhao
- School of Public Health, Chongqing Medical University, Chongqing 400331, China; (K.J.); (L.Z.); (Z.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
- Chongqing Key Laboratory of Child Nutrition and Heath, Children’s Hospital of Chongqing Medical University, Chongqing 401147, China
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Tabet M, Kirby RS, Xaverius P. Factors associated with unmet pediatric health care needs during the coronavirus pandemic. J Pediatr Nurs 2023; 73:e204-e212. [PMID: 37735040 DOI: 10.1016/j.pedn.2023.09.011] [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: 07/27/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To examine risk factors for unmet pediatric health care needs during the coronavirus pandemic in a national sample of US children under 17 years of age. DESIGN AND METHODS In this cross-sectional study, we used data from the 2021 National Survey of Children's Health (n = 50,892). Unmet pediatric health care needs were assessed as follows: "during the past 12 months, was there any time when this child needed health care but it was not received?". Logistic regression with multiple imputations was used to evaluate bivariate and multivariable associations between predisposing, enabling, and need factors of health care services use and unmet pediatric health care needs. RESULTS Approximately 3.6% of children had unmet health care needs, with significant differences by sample characteristics. Unmet health care needs were notably prevalent among select groups, including children with difficulty covering basic needs (10.6%) and those with ≥2 health conditions (8.9%). In multivariable analyses, factors associated with unmet pediatric health care needs included predisposing factors such as older age, ≥2 children with special health care needs in the household, primary language other than English or Spanish, and poor caregiver health; enabling factors such as difficulty covering basic needs, no insurance, and no personal doctor or nurse; and need factors such as poor perceived or evaluated child health. Reasons for unmet needs included financial, nonfinancial, and accessibility barriers. CONCLUSIONS Several factors were associated with unmet health care needs. PRACTICE IMPLICATIONS We identified children who would benefit from targeted interventions aimed at promoting health care services use.
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Affiliation(s)
- Maya Tabet
- College of Global Population Health, University of Health Sciences and Pharmacy in St. Louis, 1 Pharmacy Place, St. Louis, MO 63110, USA.
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, 4202 E Fowler Ave, Tampa, FL 33620, USA.
| | - Pamela Xaverius
- Office of Research and Scholarly Activity, University of Health Sciences and Pharmacy in St. Louis, 1 Pharmacy Place, St. Louis, MO 63110, USA.
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Song M, Le TTA, Denny S, Lennox NG, McPherson L, Ware RS, Harley D. Reasons for Encounters and Comorbidities in Adolescents with Intellectual Disability in General Practice: A Retrospective Analysis of Data from the Ask Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1450. [PMID: 37761411 PMCID: PMC10528096 DOI: 10.3390/children10091450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Adolescents with intellectual disability have substantial health needs. This retrospective analysis of data from the Ask Study describes reasons for primary care encounters and the prevalence and incidence of chronic physical and mental conditions among a cohort of community-dwelling adolescents with intellectual disability. Participants attended secondary schools in southern Queensland, Australia. Primary care data were extracted from primary care records. Demographic and health information was collected using carer-completed questionnaires. Reasons for primary care encounters, disease prevalence at age 16 years, and disease incidence through adolescence were reported. Data were obtained for 432 adolescents with intellectual disability (median follow-up: 4.1 years). Skin problems (29.4 per 100 encounters) were the most common reason patients presented for primary care, followed by psychological and behavioural problems (14.4 per 100 encounters) and musculoskeletal problems (13.8 per 100 encounters). Conditions with the highest prevalence were autism spectrum disorder (18.6%) and asthma (18.1%). The prevalence of epilepsy, visual impairment, and cerebral palsy were 14.7, 11.1, and 8.0%, respectively. Gastroesophageal reflux had the highest incidence (9.4 cases per 1000 person-years). Adolescents with intellectual disability have significant healthcare needs, which general practitioners need to be aware of and address. Study findings should inform the development of training programs for general practitioners.
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Affiliation(s)
- Menghuan Song
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
| | - Tran T. A. Le
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
- Department of Psychiatry, University of Medicine and Pharmacy, Hue University, Hue 530000, Vietnam
| | - Simon Denny
- Mater Young Adult Health Centre, Mater Hospitals, Brisbane, QLD 4072, Australia;
| | - Nicholas G. Lennox
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
| | - Lyn McPherson
- Menzies Health Institute Queensland, School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia;
| | - Robert S. Ware
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
- Menzies Health Institute Queensland, School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia;
| | - David Harley
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
- Centre for Clinical Research, University of Queensland, Brisbane, QLD 4006, Australia
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12
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Hoopes AJ, Cushing-Haugen KL, Coley RY, Fuller S, White C, Ralston JD, Mangione-Smith R. Characteristics of Adolescents Who Use Secure Messaging on a Health System's Patient Portal. Pediatrics 2023; 152:e2022060271. [PMID: 37271795 PMCID: PMC10312232 DOI: 10.1542/peds.2022-060271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVES To determine adolescent characteristics associated with patient portal secure messaging use within a health system. METHODS This study analyzed monthly data from individuals aged 13 to 17 who met study eligibility criteria from 2019 to 2021. The primary outcome was any secure messages sent from an adolescent's account during each observed month. Unadjusted and adjusted associations between adolescent characteristics and secure messaging use were assessed using generalized estimating equations with log link and binomial variance. RESULTS Of 667 678 observed months, 50.8% occurred among males who were not transgender, 51.5% among those identifying as non-Hispanic white, and 83.3% among the privately insured. The adjusted relative risks of secure messaging use were significantly higher for individuals with female sex and transgender identities (female sex, not transgender: adjusted relative risk [aRR] 1.41, 95% confidence interval [CI] 1.31-1.52; male sex, transgender: aRR 2.39, CI 1.98-2.90, female sex, transgender: aRR 3.01, 95% CI 2.63-3.46; referent male sex, not transgender), those with prior portal use (aRR 22.06, 95% CI 20.48-23.77; referent no use) and those with a recent preventive care visit (aRR 1.09, 95% CI 1.02-1.16; referent no recent visits). The adjusted relative risks of portal secure messaging use were significantly lower among those with public insurance (aRR 0.58, 95% CI 0.50-0.67; referent private). CONCLUSIONS Adolescents who sent patient portal secure messages differed from those who did not. Interventions to encourage secure messaging use may require tailoring based on patient characteristics.
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Affiliation(s)
- Andrea J. Hoopes
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - R. Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Sharon Fuller
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Cicely White
- Kaiser Permanente Washington, Seattle, Washington
| | - James D. Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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13
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Pygott N, Hartley A, Seregni F, Ford TJ, Goodyer IM, Necula A, Banu A, Anderson JK. Research Review: Integrated healthcare for children and young people in secondary/tertiary care - a systematic review. J Child Psychol Psychiatry 2023. [PMID: 36941107 DOI: 10.1111/jcpp.13786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Children and young people (CYP) with comorbid physical and/or mental health conditions often struggle to receive a timely diagnosis, access specialist mental health care, and more likely to report unmet healthcare needs. Integrated healthcare is an increasingly explored model to support timely access, quality of care and better outcomes for CYP with comorbid conditions. Yet, studies evaluating the effectiveness of integrated care for paediatric populations are scarce. AIM AND METHODS This systematic review synthesises and evaluates the evidence for effectiveness and cost-effectiveness of integrated care for CYP in secondary and tertiary healthcare settings. Studies were identified through systematic searches of electronic databases: Medline, Embase, PsychINFO, Child Development and Adolescent Studies, ERIC, ASSIA and British Education Index. FINDINGS A total of 77 papers describing 67 unique studies met inclusion criteria. The findings suggest that integrated care models, particularly system of care and care coordination, improve access and user experience of care. The results on improving clinical outcomes and acute resource utilisation are mixed, largely due to the heterogeneity of studied interventions and outcome measures used. No definitive conclusion can be drawn on cost-effectiveness since studies focused mainly on costs of service delivery. The majority of studies were rated as weak by the quality appraisal tool used. CONCLUSIONS The evidence of on clinical effectiveness of integrated healthcare models for paediatric populations is limited and of moderate quality. Available evidence is tentatively encouraging, particularly in regard to access and user experience of care. Given the lack of specificity by medical groups, however, the precise model of integration should be undertaken on a best-practice basis taking the specific parameters and contexts of the health and care environment into account. Agreed practical definitions of integrated care and associated key terms, and cost-effectiveness evaluations are a priority for future research.
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Affiliation(s)
- Naomi Pygott
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Alex Hartley
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Francesca Seregni
- Department of Paediatrics, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ian M Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Andreea Necula
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
| | - Arina Banu
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
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14
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Khazanchi R, Heard-Garris NJ, Winkelman TNA. Health Care Access and Use Among Children & Adolescents Exposed to Parental Incarceration-United States, 2019. Acad Pediatr 2023; 23:464-472. [PMID: 36216212 DOI: 10.1016/j.acap.2022.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The United States has the highest incarceration rate in the world, with spillover impacts on 5 million children with an incarcerated parent. Children exposed to parental incarceration (PI) have suboptimal health care access, use, and outcomes in adulthood compared to their peers. However, little is known about their access and utilization during childhood. We evaluated relationships between PI and health care use and access throughout childhood and adolescence. METHODS We analyzed the nationally representative 2019 National Health Interview Survey Child Sample to examine cross-sectional associations between exposure to incarceration of a residential caregiver, access to care, and health care use among children aged 2-17. Respondents were asked about measures of preventive care access, unmet needs due to cost, and acute care use over the last year. We estimated changes associated with PI exposure using multiple logistic regression models adjusted for age, sex, race, ethnicity, parental education, family structure, rurality, income, insurance status, and disability. RESULTS Of 7405 sample individuals, 467 (weighted 6.2% [95% CI 5.5-6.9]) were exposed to PI. In adjusted analyses to produce national estimates, exposure to PI was associated with an additional 2.2 million children lacking a usual source of care, 2 million with forgone dental care needs, 1.2 million with delayed mental health care needs, and 865,000 with forgone mental health care needs. CONCLUSIONS Exposure to PI was associated with worse access to a usual source of care and unmet dental and mental health care needs. Our findings highlight the need for early intervention by demonstrating that these barriers emerge during childhood and adolescence.
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Affiliation(s)
- Rohan Khazanchi
- Health, Homelessness, and Criminal Justice Lab (R Khazanchi and TNA Winkelman), Hennepin Healthcare Research Institute, Minneapolis, Minn; School of Public Health (R Khazanchi), University of Minnesota, Minneapolis, Minn; College of Medicine (R Khazanchi), University of Nebraska Medical Center, Omaha, Nebr.
| | - Nia J Heard-Garris
- Division of Advanced General Pediatrics, Department of Pediatrics and Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center (NJ Heard-Garris), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital, Chicago, Ill; Department of Pediatrics (NJ Heard-Garris), Northwestern University Feinberg School of Medicine, Chicago, Ill; Institute for Policy Research (NJ Heard-Garris), Northwestern University, Chicago, Ill
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab (R Khazanchi and TNA Winkelman), Hennepin Healthcare Research Institute, Minneapolis, Minn; Division of General Internal Medicine (NA Winkelman), Department of Medicine, Hennepin Healthcare, Minneapolis, Minn
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15
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Fox DJ, Hanes D. Prevalence and Correlates of Unmet Mental Health Services Need in Adolescents With Major Depressive Episode in 2019: An Analysis of National Survey on Drug Use and Health Data. J Adolesc Health 2023; 72:182-188. [PMID: 36424335 DOI: 10.1016/j.jadohealth.2022.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/04/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Mental health (MH) crises in adolescence can derail development, possibly leading to poorer health outcomes in young adulthood. According to recent estimates, approximately half of US children have unmet MH need, with increased odds when uninsured or Hispanic. The aims of this study were to update estimates of MH services need and use in the US adolescent (12- 17 years) and to reassess previously identified associations between insurance status, demographic characteristics, MH need and use, and unmet need, using data from the National Survey of Drug Use and Health (NSDUH; 2019). METHODS Adolescents aged 12-17 years were included from the NSDUH. Logistic regressions were performed to assess associations of race and insurance with outcomes of past-year major depressive episode (MDE) and unmet MH need. Adjustments were made for age, sex, and income. RESULTS Individuals of multiple races, females, and users of alcohol, marijuana, and illicit drugs had increased odds of MDE, while Black adolescents and the privately insured had decreased odds. Hispanic adolescents, people of multiple races, and users of alcohol and illicit drug had increased odds for unmet need. DISCUSSION We estimate that 15.8% of all US adolescents had an MDE and that 45.8% of these adolescents with MDE went without MH care in 2019. We found very limited support for associations of race and insurance status with past-year MDE or unmet MH need, although this may be due to the small number of uninsured adolescents sampled in 2019. Longitudinal data are needed to assess severity of MH needs and appropriateness of care.
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Affiliation(s)
- Devon J Fox
- Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon.
| | - Douglas Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon
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16
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Chung W. Changes in Barriers That Cause Unmet Healthcare Needs in the Life Cycle of Adulthood and Their Policy Implications: A Need-Selection Model Analysis of the Korea Health Panel Survey Data. Healthcare (Basel) 2022; 10:2243. [PMID: 36360584 PMCID: PMC9691171 DOI: 10.3390/healthcare10112243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 01/31/2024] Open
Abstract
Using 68,930 observations selected from 16,535 adults in the Korea Health Panel Survey (2014-2018), this study explored healthcare barriers that prevent people from meeting their healthcare needs most severely during adulthood, and the characteristics that are highly associated with the barrier. This study derived two outcome variables: a dichotomous outcome variable on whether an individual has experienced healthcare needs, and a quadchotomous outcome variable on how an individual's healthcare needs ended. An analysis was conducted using a multivariable panel multinomial probit model with sample selection. The results showed that the main cause of unmet healthcare needs was not financial difficulties but non-financial barriers, which were time constraints up to a certain age and the lack of caring and support after that age. People with functional limitations were at a high risk of experiencing unmet healthcare needs due to a lack of caring and support. To reduce unmet healthcare needs in South Korea, the government should focus on lowering non-financial barriers to healthcare, including time constraints and lack of caring and support. It seems urgent to strengthen the foundation of "primary care", which is exceptionally scarce now, and to expand it to "community-based integrated care" and "people-centered care".
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
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17
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Kerba J, Demers C, Bélanger V, Napartuk M, Bouchard I, Meloche C, Morel S, Prud’homme N, Gélinas I, Higgins J, Curnier D, Sultan S, Laverdière C, Sinnett D, Marcil V. Needs, Barriers and Facilitators of Adolescents Participating in a Lifestyle Promotion Program in Oncology: Stakeholders, Adolescents and Parents’ Perspective. CHILDREN 2022; 9:children9091340. [PMID: 36138649 PMCID: PMC9497682 DOI: 10.3390/children9091340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/17/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022]
Abstract
Treatments for adolescent cancer can cause debilitating side effects in the short- and long-term such as nausea and malnutrition but also cardiometabolic disturbances. Although the risk for cardiometabolic complications is greater for adolescents with cancer than younger ones, adolescents typically respond poorly to family-oriented health promotion programs. This study aims to assess the needs, barriers and facilitators to healthy lifestyle promotion interventions for adolescents with cancer and how to best adapt these interventions for them. Interviews were held with adolescents treated for cancer (n = 9) and parents (n = 6), focus groups were conducted with stakeholders working in oncology (n = 12) and self-report questionnaires were sent to stakeholders involved in a health promotion intervention (n = 6). At the time of interview, mean age of adolescent participants (40% female) was 17.0 ± 1.9 years (mean age at diagnosis: 14.6 ± 1.6 years). Verbatim and responses to questionnaires were coded and analyzed using qualitative methods. Stakeholder stated that adolescents with cancer need to access activities adapted to their age, to communicate with peers going through a similar experience, and to preserve their schooling and friendships. Barriers to intervention reported by adolescents, parents and stakeholders include lack of motivation, schedule conflicts, fatigue and treatment side effects. Some of the barriers mentioned by adolescents and parents include pain, post-surgery problems, school, physical deconditioning, and lack of time. Facilitators mentioned by adolescents and parents comprise trust in stakeholders’ expertise, personalized approaches, scheduling flexibility. Stakeholders recommended to build trust in the relationship, favoring non-moralizing teachings, adapt interventions to adolescents’ limited attention span and avoiding the use of long-term health benefits as a motivator.
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Affiliation(s)
- Johanne Kerba
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Université de Montreal, Montreal, QC H3T 1A8, Canada
- Cardiometabolic Health, Diabetes, and Obesity Research Network (CMDO), Montreal, QC J1H 5N4, Canada
| | - Catherine Demers
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
| | - Véronique Bélanger
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Université de Montreal, Montreal, QC H3T 1A8, Canada
- Cardiometabolic Health, Diabetes, and Obesity Research Network (CMDO), Montreal, QC J1H 5N4, Canada
- Institute of Nutrition and Functional Food, Quebec City, QC G1V 0A6, Canada
| | - Mélanie Napartuk
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Université de Montreal, Montreal, QC H3T 1A8, Canada
- Cardiometabolic Health, Diabetes, and Obesity Research Network (CMDO), Montreal, QC J1H 5N4, Canada
- Institute of Nutrition and Functional Food, Quebec City, QC G1V 0A6, Canada
| | - Isabelle Bouchard
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Caroline Meloche
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Sophia Morel
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Université de Montreal, Montreal, QC H3T 1A8, Canada
- Cardiometabolic Health, Diabetes, and Obesity Research Network (CMDO), Montreal, QC J1H 5N4, Canada
- Institute of Nutrition and Functional Food, Quebec City, QC G1V 0A6, Canada
| | - Nicolas Prud’homme
- Division of Hematology-Oncology, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Isabelle Gélinas
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
| | - Johanne Higgins
- School of Rehabilitation, Université de Montréal, Montreal, QC H3N 1X7, Canada
| | - Daniel Curnier
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Serge Sultan
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Caroline Laverdière
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - Daniel Sinnett
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - Valérie Marcil
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Université de Montreal, Montreal, QC H3T 1A8, Canada
- Cardiometabolic Health, Diabetes, and Obesity Research Network (CMDO), Montreal, QC J1H 5N4, Canada
- Institute of Nutrition and Functional Food, Quebec City, QC G1V 0A6, Canada
- Correspondence: ; Tel.: +1-514-345-4931-(3272)
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18
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Bottle A, Neale FK, Foley KA, Viner RM, Kenny S, Aylin P, Saxena S, Hargreaves DS. Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study. BMJ Open 2022; 12:e060961. [PMID: 35940830 PMCID: PMC9364042 DOI: 10.1136/bmjopen-2022-060961] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people. SETTING All National Health Service (public) hospitals in England. PARTICIPANTS All people in England aged <25 years. OUTCOME MEASURES Outpatient department attendance numbers, rates and modes (face to face vs telephone) by age group, sex and socioeconomic deprivation. RESULTS Compared with the average for January 2017 to December 2019, there was a 3.8 million appointment shortfall (23.5%) for the under-25 population in England between March 2020 and February 2021, despite a total rise in phone appointments of 2.6 million during that time. This was true for each age group, sex and deprivation fifth, but there were smaller decreases in face to face and total appointments for babies under 1 year. For all ages combined, around one in six first and one in four follow-up appointments were by phone in the most recent period. The proportion of appointments attended was high, at over 95% for telephone and over 90% for face-to-face appointments for all ages. CONCLUSIONS COVID-19 led to a dramatic fall in total outpatient appointments and a large rise in the proportion of those appointments conducted by telephone. The impact that this has had on patient outcomes is still unknown. The differential impact of COVID-19 on outpatient activity in different sociodemographic groups may also inform design of paediatric outpatient services in the post-COVID period.
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Affiliation(s)
- Alex Bottle
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Francesca K Neale
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Kimberley A Foley
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Simon Kenny
- National Clinical Director, NHS England and NHS Improvement, London, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Paul Aylin
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
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19
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Nachiappan N, Mackinnon S, Ndayizeye JP, Greenfield G, Hargreaves D. Barriers to accessing health care among young people in 30 low-middle income countries. Health Sci Rep 2022; 5:e733. [PMID: 35873403 PMCID: PMC9297382 DOI: 10.1002/hsr2.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 06/12/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Previous studies focusing on high-income countries have shown that young people often face greater barriers to accessing healthcare than older adults. However, in low-middle income countries (LMICs), there have been a paucity of cross-country, quantitative studies highlighting these barriers. Aim This exploratory study aims to provide a scoping review of the publicly available Demographic and Heath Survey (DHS) data with a view to form the basis for further work. Materials and methods Data on insurance coverage, agency, and access to evidence-based family planning from 30 countries in the DHS were compared between age groups. Data on 586,250 participants 15-24 years (33% male) and 854,660 participants 25-49 years (16% male) from 30 LMICs were analyzed. Results Significantly greater barriers to accessing healthcare were observed across six variables in younger population when compared to older adults across all survey questions with an average of 8.4% point difference. Also, there was wide country-level variation: the maximum differences between age groups were 33% points; Rwanda was the only country with no age differences. Discussion This study highlights several possible themes for future research into improving access to healthcare for young people. These themes include more detailed evaluation of country-specific policies to reduced barriers to healthcare for young people and further research into the causative factors that can influence healthcare utilization by young people. Conclusion Our analysis showcases increased barriers to healthcare access for young people in LMICs. We argue that they can only be improved by targeted policies and direct community engagement.
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Affiliation(s)
| | - Shona Mackinnon
- Division of Basic Medical SciencesUniversity of Global Health EquityKigaliRwanda
| | - Jean P. Ndayizeye
- Division of Basic Medical SciencesUniversity of Global Health EquityKigaliRwanda
| | - Geva Greenfield
- School of Public HealthImperial College School of MedicineLondonUK
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20
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Armitage AJ, Cohen J, Heys M, Hardelid P, Ward A, Eisen S. Description and evaluation of a pathway for unaccompanied asylum-seeking children. Arch Dis Child 2022; 107:456-460. [PMID: 34656979 DOI: 10.1136/archdischild-2021-322319] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/23/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE (1) To describe a novel integrated pathway for unaccompanied asylum-seeking children (UASC).(2) To evaluate a population engaged with this service. DESIGN Description of the integrated pathway (objective 1) and retrospective evaluation, using data from community paediatrics, infectious diseases (IDs) screening and a sexual health (SH) service (objective 2). SETTING Unlinked data were collected from three services across three National Health Service (NHS) trusts in London. PATIENTS All Camden UASC engaged with the service from 01 January 2016 to 30 March 2019. INTERVENTIONS A multidisciplinary approach prioritising the health needs of UASC including a childre and adolescent mental health service (CAMHS) clinican and a health improvement practitioner. There are low thresholds for onward referral and universal asymptomatic screening of UASC for ID. MAIN OUTCOME MEASURES Data on demographics, unmet health needs and known outcomes. RESULTS Data were available for 101 UASC, 16% female, median age 16 years (range 14-17). Physical assault/abuse was reported in 67% and 13% disclosed sexual assault/abuse, including 38% of female UASC. Mental health symptoms were documented in 77%. IDs warranting treatment were identified in 41% including latent tuberculosis (25%) and schistosomiasis (13%). Interpreters were required for 97% and initial non-attendance rates at follow-up were 40% (ID) and 49% (SH). CONCLUSIONS These data demonstrate high rates of historical physical and sexual assault/abuse, unmet physical, mental and emotional health needs among UASC and significant barriers to engaging with services. An integrated pathway has been successfully implemented and shown to deliver appropriate, joined-up care for UASC, consistent with current recommendations, with the potential to improve outcomes.
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Affiliation(s)
- Alice Jane Armitage
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK .,Paediatric Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jonathan Cohen
- Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK
| | - Michelle Heys
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Pia Hardelid
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Allison Ward
- Community Paediatrics, Central and North West London NHS Foundation Trust, London, UK
| | - Sarah Eisen
- Paediatric Department, University College London Hospitals NHS Foundation Trust, London, UK
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21
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Carbonaro R. System avoidance and social isolation: Mechanisms connecting police contact and deleterious health outcomes. Soc Sci Med 2022; 301:114883. [PMID: 35313218 DOI: 10.1016/j.socscimed.2022.114883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/16/2022] [Accepted: 03/07/2022] [Indexed: 11/19/2022]
Abstract
A growing body of literature suggests even routine or low-level contact with the criminal justice system impacts health outcomes. In this paper, I examine two mechanisms by which police contact contributes to deleterious health outcomes: system avoidance and social isolation. I use data from 12,016 respondents from the National Longitudinal Study of Adolescent to Adult Health, a longitudinal and nationally representative sample. Findings suggest system avoidance may be an important mechanism by which police stops shape health outcomes. Whether social isolation serves as a mechanism varies based on how it is measured. Results suggest police stops are associated with subjective feelings of loneliness, which in turn explained some of the association between police stops and health outcomes. Notably, women were more likely to exhibit system avoidance and poor health following police contact compared to men.
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Affiliation(s)
- Richard Carbonaro
- Department of Sociology, University of Massachusetts Amherst, 200 Hicks Way, Amherst, MA, 01003, USA.
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22
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Chung W. Characteristics Associated With Financial or Non-financial Barriers to Healthcare in a Universal Health Insurance System: A Longitudinal Analysis of Korea Health Panel Survey Data. Front Public Health 2022; 10:828318. [PMID: 35372247 PMCID: PMC8971121 DOI: 10.3389/fpubh.2022.828318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
While many studies have explored the financial barriers to healthcare, there is little evidence regarding the non-financial barriers to healthcare. This study identified characteristics associated with financial and non-financial barriers to healthcare and quantified the effects of these characteristics in South Korea, using a nationally representative longitudinal survey dataset. Overall, 68,930 observations of 16,535 individuals aged 19 years and above were sampled from Korea Health Panel survey data (2014-2018). From self-reported information about respondents' experiences of unmet healthcare needs, a trichotomous dependent variable-no barrier, non-financial barrier, and financial barrier-was derived. Sociodemographics, physical and health conditions were included as explanatory variables. The average adjusted probability (AAP) of experiencing each barrier was predicted using multivariable and panel multinomial logistic regression analyses. According to the results, the percentage of people experiencing non-financial barriers was much higher than that of people experiencing financial barriers in 2018 (9.6 vs. 2.5%). Women showed higher AAPs of experiencing both non-financial (9.9 vs. 8.3%) and financial barriers (3.6 vs. 2.5%) than men. Men living in the Seoul metropolitan area showed higher AAPs of experiencing non-financial (8.7 vs. 8.0%) and financial barriers (3.4 vs. 2.1%) than those living outside it. Household income showed no significant associations in the AAP of experiencing a non-financial barrier. People with a functional limitation exhibited a higher AAP of experiencing a non-financial barrier, for both men (17.8 vs. 7.8%) and women (17.4 vs. 9.0%), than those without it. In conclusion, people in South Korea, like those in most European countries, fail to meet their healthcare needs more often due to non-financial barriers than financial barriers. In addition, the characteristics associated with non-financial barriers to healthcare differed from those associated with financial barriers. This finding suggests that although financial barriers may be minimised through various policies, a considerable degree of unmet healthcare needs and disparity among individuals is very likely to persist due to non-financial barriers. Therefore, current universal health insurance systems need targeted policy instruments to minimise non-financial barriers to healthcare to ensure effective universal health coverage.
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
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Ghafari M, Nadi T, Bahadivand-Chegini S, Doosti-Irani A. Global prevalence of unmet need for mental health care among adolescents: A systematic review and meta-analysis. Arch Psychiatr Nurs 2022; 36:1-6. [PMID: 35094819 DOI: 10.1016/j.apnu.2021.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 07/07/2021] [Accepted: 10/18/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Globally mental disorders affect a large number of adolescents. The unmet need for health care of mental health problems is common among adolescents. The aim of this systematic review and meta-analysis was to estimate the global prevalence of unmet needs of mental health care among adolescents. METHODS PubMed, Web of Sciences and Scopus, were searched by June 2018 using a pre-designed search strategy. The summary measure was the prevalence of unmet need for mental health care. The inverse variance method was used in meta-analysis, and the results were reported using the random-effects model at a 95% confidence interval (CI). RESULTS Out of 30,154 retrieved studies, 15 cross-sectional studies met the eligibility criteria and included in the meta-analysis. The included studies involved 51,309 participants, which 34,476 of them required the mental health care services. The overall pooled prevalence of unmet need for mental health care was 54.0% (95% CI: 41.0, 67.0; I2 = 99.9%). Prevalence among adolescents with any mental disorder, general population of adolescents, and high-risk adolescents were 58.1 (46.8, 69.5), 51.4 (30.2, 72.7), and 31.0 (29.0, 33.0) respectively. CONCLUSION Based on the results of this systematic review a considerable proportion of adolescents with mental health problems, have not received the required mental health care.
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Affiliation(s)
- Mahin Ghafari
- Department of Public Health, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Tayebeh Nadi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Samira Bahadivand-Chegini
- Department of Epidemiology, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amin Doosti-Irani
- Department of Public Health, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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Geirhos A, Domhardt M, Lunkenheimer F, Temming S, Holl RW, Minden K, Warschburger P, Meissner T, Mueller-Stierlin AS, Baumeister H. Feasibility and potential efficacy of a guided internet- and mobile-based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACH CD): a randomized controlled pilot trial. BMC Pediatr 2022; 22:69. [PMID: 35093047 PMCID: PMC8800235 DOI: 10.1186/s12887-022-03134-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/11/2022] [Indexed: 01/20/2023] Open
Abstract
Background Adolescents and young adults (AYA) with a chronic medical condition show an increased risk for developing mental comorbidities compared to their healthy peers. Internet- and mobile-based cognitive behavioral therapy (iCBT) might be a low-threshold treatment to support affected AYA. In this randomized controlled pilot trial, the feasibility and potential efficacy of youthCOACHCD, an iCBT targeting symptoms of anxiety and depression in AYA with chronic medical conditions, was evaluated. Methods A total of 30 AYA (Mage 16.13; SD= 2.34; 73% female), aged 12-21 years either suffering from cystic fibrosis, juvenile idiopathic arthritis or type 1 diabetes, were randomly assigned to either a guided version of the iCBT youthCOACHCD (IG, n=15) or to a waitlist control group (CG, n=15), receiving an unguided version of the iCBT six months post-randomization. Participants of the IG and the CG were assessed before (t0), twelve weeks after (t1) and six months after (t2) randomization. Primary outcome was the feasibility of the iCBT. Different parameters of feasibility e.g. acceptance, client satisfaction or potential side effects were evaluated. First indications of the possible efficacy with regard to the primary efficacy outcome, the Patient Health Questionnaire Anxiety and Depression Scale, and further outcome variables were evaluated using linear regression models, adjusting for baseline values. Results Regarding feasibility, intervention completion was 60%; intervention satisfaction (M = 25.42, SD = 5.85) and perceived therapeutic alliance (M = 2.83, SD = 1.25) were moderate and comparable to other iCBTs. No patterns emerged regarding subjective and objective negative side effects due to participation in youthCOACHCD. Estimates of potential efficacy showed between group differences, with a potential medium-term benefit of youthCOACHCD (β = -0.55, 95%CI: -1.17; 0.07), but probably not short-term (β = 0.20, 95%CI: -0.47; 0.88). Conclusions Our results point to the feasibility of youthCOACHCD and the implementation of a future definitive randomized controlled trial addressing its effectiveness and cost-effectiveness. Due to the small sample size, conclusions are premature, however, further strategies to foster treatment adherence should be considered. Trial registration The trial was registered at the WHO International Clinical Trials Registry Platform via the German Clinical Trials Register (ID: DRKS00016714, 25/03/2019). Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03134-3.
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Affiliation(s)
- A Geirhos
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany. .,Faculty of Engineering, Computer Science and Psychology Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Lise-Meitner-Straße 16, 89081, Ulm, Germany.
| | - M Domhardt
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - F Lunkenheimer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - S Temming
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - R W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | - K Minden
- Charité University Medicine Berlin, Berlin, Germany.,German Rheumatism Research Centre, Berlin, Germany
| | - P Warschburger
- Department of Psychology, Counseling Psychology, University of Potsdam, Potsdam, Germany
| | - T Meissner
- Department of General, Paediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - A S Mueller-Stierlin
- Department of Psychiatry and Psychotherapy II, BKH Günzburg, Ulm University, Günzburg, Germany
| | - H Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
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White J, Morris H, Cortright L, Buckman C, Tumin D, Jamison S. Concordance of Data on Children's Unmet Health Care Needs Between 2 National Surveys. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E155-E161. [PMID: 32810072 DOI: 10.1097/phh.0000000000001223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We used public data from 2 national surveys to determine how survey mode and questionnaire wording potentially impact estimated prevalence and predictors of children's unmet health care needs. METHODS Data from 2016-2017 were obtained for the National Health Interview Survey (NHIS), where interviewers ask caregivers about each type of unmet health care need in person, and the National Survey of Children's Health (NSCH), a self-administered questionnaire asking a general question about any unmet health care needs, with subparts about specific types of unmet needs. Weighted proportions and multivariable logistic regression were used to analyze each data set. RESULTS The weighted proportion of any unmet health care needs was significantly higher in the NHIS (7.5%; 95% confidence interval [CI], 7.0-8.1; N = 17 723) than in the NSCH (3.3%; 95% CI, 2.9-3.7; N = 65 766). When analyzing specific unmet needs, unmet need for dental care was significantly higher according to the NHIS (4.2% vs 1.9% in the NSCH), as was unmet need for vision care (1.7% vs 0.8%). Conversely, estimates of unmet need for medical care were comparable between the surveys (1.4% and 1.0%). On multivariable analysis, predictors of unmet health care needs, such as being uninsured, had effect sizes of similar magnitude in both surveys. CONCLUSION The NHIS design, asking about each type of unmet need in person, may have been more conducive to identifying the full range of unmet health care needs among children. However, our results did not indicate that this was a source of bias in multivariable regression analysis.
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Affiliation(s)
- Jessiya White
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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Brittain AW, Steiner RJ, Fasula AM, Hatfield-Timajchy K, Kulkarni A, Koumans EH. Improving Access to and Quality of Sexual and Reproductive Health Services for Adolescents in the United States. J Womens Health (Larchmt) 2022; 31:7-12. [PMID: 35023768 PMCID: PMC10961097 DOI: 10.1089/jwh.2021.0610] [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] [Indexed: 11/12/2022] Open
Abstract
Equitable access to high quality adolescent sexual and reproductive health (ASRH) services can help reduce unintended pregnancies, sexually transmitted diseases, and disparities in these outcomes. The Centers for Disease Control and Prevention (CDC), Division of Reproductive Health, has a long history of working to improve access to and quality of ASRH services through applied research and public health practice. This report from CDC summarizes the evolution of these efforts from more than a decade of work-from community-based demonstration projects to an initiative to support wide-scale implementation. We describe a community-wide teen pregnancy prevention program model that includes a component addressing ASRH services (2010-2015), focused efforts related to quality improvement (QI) of and community-clinic linkages to ASRH services (2015-2020), and the development of a QI package that collates implementation strategies and tools to improve ASRH services (2020-2022). We conclude by discussing future directions. In disseminating key strategies and resources from this work, we aim to support broader public health and clinical efforts to strengthen ASRH care in the United States in ways that promote health equity.
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Affiliation(s)
- Anna W Brittain
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Riley J Steiner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy M Fasula
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kendra Hatfield-Timajchy
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aniket Kulkarni
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emilia H Koumans
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Park H, Park J. Prevalence of Unmet Healthcare Needs in Adolescents and Associated Factors: Data from the Seventh Korea National Health and Nutrition Examination Survey (2016-2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312781. [PMID: 34886504 PMCID: PMC8657423 DOI: 10.3390/ijerph182312781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
Adolescent health is considered the basis of adult health, and the unmet healthcare needs in adolescents are an important issue to be solved. This study, therefore, aimed to explore the prevalence of unmet healthcare needs, and examine its associated factors among adolescents in Korea based on Andersen's Behavioral Model of Health Services, using data from the Seventh Korea National Health and Nutrition Examination Survey (2016 to 2018). This survey's data source comprised 12- to 18-year-old adolescents, of which 1425 provided information on their unmet healthcare needs, as well as their predisposing, enabling, and need factors. For statistical analysis, SPSS version 25.0 was used. Descriptive analyses were performed to assess each variable, whereas multiple logistic regression was used to determine the associated factors. The overall prevalence of unmet healthcare needs was 5.5%. The factors that had statistically significant relationships with adolescents' unmet healthcare needs were: age; stress perceptions; housing types; and perceived health status. Unlike previous studies that presented related factors on vulnerable groups, this study's results presented unmet healthcare needs and related factors for all Korean adolescents using a national survey dataset. Hence, its findings could provide feedback on current policies, and guide future studies.
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Affiliation(s)
- Hyeran Park
- College of Nursing, Hanyang University, Seoul 04763, Korea;
- College of Nursing, Yonsei University, Seoul 03722, Korea
| | - Jeongok Park
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-02-2228-3390
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28
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Townsend JA, Randall CL. Adolescent Dental Fear and Anxiety: Background, Assessment, and Nonpharmacologic Behavior Guidance. Dent Clin North Am 2021; 65:731-751. [PMID: 34503664 DOI: 10.1016/j.cden.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Adolescence, the period from 11 to 21 years of age, bridges the chasm between childhood and adulthood. Adolescence can be challenging as bodies, cognition, and personality go through major transformations, but it is also a time of great joy as confident adults with a clear identity develop. Dentists need to be knowledgeable about the developmental characteristics of this group because some of the cognitive and emotional changes make adolescents vulnerable to new fears. Dentists must tailor behavior guidance to this developing psyche in a way that respects independence and promotes confidence to foster lifelong positive views of dentistry.
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Affiliation(s)
- Janice A Townsend
- Department of Dentistry, Nationwide Children's Hospital, 700 Children's Drive, LA Suite 5A, Columbus, OH 43205, USA; Division of Pediatric Dentistry, The Ohio State University, Columbus, OH, USA.
| | - Cameron L Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry, 1959 NE Pacific Street, Box 357475, Seattle, WA 98195, USA
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Dangol G, Poudel KC, Kim-Mozeleski JE. The Role of Parental Involvement in Cigarette Smoking among Adolescents in Nepal. J Psychoactive Drugs 2021; 54:110-118. [PMID: 34278947 DOI: 10.1080/02791072.2021.1923875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Limited studies have examined the role of a parent's involvement in their child's daily life as it relates to cigarette smoking among adolescents in low- and middle-income countries (LMICs). We examined the role of parental involvement with current smoking among 6,105 adolescents using a nationally representative sample from the 2015- 2016 Global School-based Students Health Survey in Nepal. Using the adolescents' perceptions of daily parental involvement, a composite variable was created to include parents (a) checking to see if the child's homework was done, (b) understanding the child's problems and worries, and (c) knowing what the child was doing with their free time. Our analysis utilized a multiple logistic regression to calculate adjusted odds ratios (aOR) accounting for significant covariates. Overall, an increase in parental involvement was associated with a 15% less (aOR = 0.86) likelihood of their child smoking. Additionally, being 15 years or older (aOR =1.55), being bullied (aOR =1.72), drinking alcohol (aOR =20.63), and having missed school without permission (aOR =2.29) were all associated with cigarette smoking. Further, girls were almost 70% less (aOR = 0.33) likely to be cigarette smokers than boys. Future longitudinal studies should examine parental involvement as a protective factor against cigarette smoking.
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Affiliation(s)
- Gaurav Dangol
- Department of Biostatistics & Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Krishna C Poudel
- Department of Health Promotion & Policy, University of Massachusetts Amherst, Amherst, MA, USA.,Institute for Global Health, University of Massachusetts Amherst, Amherst, MA, USA
| | - Jin E Kim-Mozeleski
- Prevention Research Center for Healthy Neighborhoods, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
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Armitage AJ, Heys M, Lut I, Hardelid P. Health outcomes in international migrant children: protocol for a systematic review. BMJ Open 2021; 11:e041173. [PMID: 33941623 PMCID: PMC8098942 DOI: 10.1136/bmjopen-2020-041173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Migration status is a key determinant of health, but health outcomes among migrant children and young people (CYP), that is, those aged under 18 years, are poorly understood. A 'healthy migrant' effect has been demonstrated among adults, but evidence for the same effect in CYP is lacking. No large studies or reviews exist reporting comprehensive or holistic health outcomes among migrant CYP. We aim to identify and synthesise original quantitative research on health of migrant CYP to explore the relations between migration status and health outcomes. METHODS AND ANALYSIS A search of PubMed/Medline, Embase, Cochrane and grey literature sites will be undertaken for any original quantitative research on health outcomes of migrant CYP from 01 January 2000 onwards. Outcomes addressed: mortality, communicable diseases, non-communicable diseases, nutritional status, mental health, disability, vaccine coverage, and accidental and non-accidental injuries (including assault and abuse). Search results will be screened and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.The Newcastle-Ottawa Scale assessment tool will be used to assess study quality. If feasible, depending on study availability data heterogeneity (explored using I2 statistic), results will be pooled for meta-analysis. If sufficient data are available, a priori defined subgroup analyses will be undertaken. A narrative quantitative synthesis will be presented, taking account of study quality and assessed risk of bias.The anticipated search completion date is 01 June 2021 with write-up completed by 01 April 2022. ETHICS AND DISSEMINATION Formal ethical approval will not be sought as we will be accessing data already in the public domain. This review will be submitted for publication in a high-impact journal and presented at international conferences. The results of this work will be shared with groups of migrant children as part of an ongoing engagement project. PROSPERO REGISTRATION NUMBER CRD42020166305.
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Affiliation(s)
- Alice Jane Armitage
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Michelle Heys
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Irina Lut
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Pia Hardelid
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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Reed NS, Assi L, Horiuchi W, Hoover-Fong JE, Lin FR, Ferrante LE, Inouye SK, Miller ER, Boss EF, Oh ES, Willink A. Medicare Beneficiaries With Self-Reported Functional Hearing Difficulty Have Unmet Health Care Needs. Health Aff (Millwood) 2021; 40:786-794. [PMID: 33939509 PMCID: PMC8323057 DOI: 10.1377/hlthaff.2020.02371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hearing loss is associated with higher health care spending and use, but little is known about the unmet health care needs of people with hearing loss or difficulty. Analysis of 2016 Medicare Current Beneficiary Survey data for beneficiaries ages sixty-five and older reveals that those who reported a lot of trouble hearing in the past year were 49 percent more likely than those who reported no trouble hearing to indicate not having a usual source of care. Compared with those who reported no trouble hearing, those who reported some trouble hearing were more likely to indicate not having obtained medical care in the past year when they thought it was needed, as well as not filling a prescription, with the risk for both behaviors being greater among those reporting a lot of trouble hearing versus a little. Interventions that improve access to hearing services and aid communication may help older Medicare beneficiaries meet their health care needs.
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Affiliation(s)
- Nicholas S. Reed
- Department of Epidemiology and in the Cochlear Center for Hearing and Public Health, both at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Lama Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health
| | - Wakako Horiuchi
- John A. Burns School of Medicine, University of Hawaii, in Honolulu, Hawaii
| | - Julie E. Hoover-Fong
- McKusick-Nathans Institute of Genetic Medicine, Department of Genetic Medicine, and the director of the Kathryn and Alan C. Greenberg Center for Skeletal Dysplasias, both at Johns Hopkins School of Medicine, in Baltimore, Maryland
| | - Frank R. Lin
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, and director of the Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health
| | - Lauren E. Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, in New Haven, Connecticut
| | - Sharon K. Inouye
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, and the director of the Aging Brain Center in the Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, both in Boston, Massachusetts
| | | | - Emily F. Boss
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine
| | - Esther S. Oh
- Department of Medicine, Johns Hopkins School of Medicine
| | - Amber Willink
- Menzies Centre for Health Policy and Economics, University of Sydney, in New South Wales, Australia
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Jung B, Ha IH. Determining the reasons for unmet healthcare needs in South Korea: a secondary data analysis. Health Qual Life Outcomes 2021; 19:99. [PMID: 33743725 PMCID: PMC7981839 DOI: 10.1186/s12955-021-01737-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background “Unmet healthcare needs” refers to the situation in which patients or citizens cannot fulfill their medical needs, likely due to socioeconomic reasons. The purpose of this study was to analyze factors related to unmet healthcare needs among South Korean adults. Methods We used a retrospective cross-sectional study design. This nationwide-based study included the data of 26,598 participants aged 19 years and older, which were obtained from the 2013–2017 Korea National Health and Nutrition Examination Surveys. Using multiple logistic regression models, we analyzed the associations between factors that influence unmet healthcare needs and participants’ subgroups. Results Despite South Korea’s universal health insurance system, in 2017, 9.5% of South Koreans experienced unmet healthcare needs. In both the male and female groups, younger people (age 19–39) had a higher odds ratio (OR) of experiencing unmet healthcare needs compared to older people (reference: age ≥ 60) (men: OR 1.83, 95% confidence interval [CI] = 1.35–2.48; women: OR 1.42, 95% CI 1.12–1.81). In particular, unlike men, women’s unmet healthcare needs increased as their incomes decreased (1 quartile OR 1.55, 2 quartiles OR 1.29, 3 quartiles OR 1.26). Men and women showed a tendency to have more unmet healthcare needs with less exercise, worse subjective health state, worse pain, and a higher degree of depression. Conclusions The contributing factors of unmet healthcare needs included having a low socioeconomic status, high stress, severe pain, and severe depression. Considering our findings, we suggest improving healthcare access for those with low socioeconomic status. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01737-5.
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Affiliation(s)
- Boyoung Jung
- Department of Health Administration, Hanyang Women's University, 200 Salgoji-gil, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 3F, 538 Gangnam-daero, Gangnam-gu, Seoul, 06110, Republic of Korea.
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Liu SY, Pabayo R, Muennig P. Perceived Discrimination and Increased Odds of Unmet Medical Needs Among US Children. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2021; 51:364-370. [PMID: 33709808 DOI: 10.1177/0020731421997087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our study examines the association between perceived discrimination due to race and unmet medical needs among a nationally representative sample of children in the United States. We used data from the 2016-2017 National Survey of Children's Health, a population-based cross-sectional survey of randomly selected parents or guardians in the United States. We compared results from the coarsened exact matching (CEM) method and survey-weighted logistic regression to assess the robustness of the results. Using self-reported measures from caregivers, we find that ∼2.7% of US children have experienced racial discrimination with prevalence varying significantly by race. While <1% of non-Hispanic whites have experienced some measure of racism, this increases to 8.8% among non-Hispanic blacks. Perceived discrimination was associated with significantly greater odds of unmet medical needs in the adjusted, survey-weighted multivariate-adjusted model (adjusted odds ratio [OR] = 2.4 and 95% confidence interval [CI] = 1.2, 4.9) as well as in the CEM-model estimate (OR = 2.8 and 95% CI = 1.8, 4.0). Children who have experienced perceived discrimination had higher odds of unmet medical needs. Awareness of discrimination among children may help inform future intervention development that addresses unmet medical needs during childhood.
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Affiliation(s)
- Sze Yan Liu
- 8087Montclair State University, Montclair, NJ, USA
| | - Roman Pabayo
- 3158University of Alberta, School of Public Health, Edmonton, AB, Canada
| | - Peter Muennig
- 33638Columbia Mailman School of Public Health, New York, NY, USA
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Hassanzadeh R, Klaber R, Watson M, Holden B, Majeed A, Hargreaves DS. Data-driven, integrated primary and secondary care for children: moving from policy to practice. J R Soc Med 2021; 114:63-68. [PMID: 33118869 PMCID: PMC7879004 DOI: 10.1177/0141076820968781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Roya Hassanzadeh
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Robert Klaber
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London W6 8RP, UK
| | - Mando Watson
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London W6 8RP, UK
| | - Ben Holden
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London W6 8RP, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
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Unmet Need for Medical Care: The Role of Mental Health Status. Community Ment Health J 2021; 57:121-127. [PMID: 32303934 DOI: 10.1007/s10597-020-00613-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/28/2020] [Indexed: 12/29/2022]
Abstract
Mental health status is an important factor to consider when exploring correlates of unmet need for medical care and prescription drugs. This paper explores whether self-rated mental health status is associated with unmet need and delays in obtaining medical care and prescription drugs. Descriptive statistics and multivariable logistic regression with 27,305 non-institutionalized adults aged 18 and older from the 2012 Medical Expenditure Panel Survey explore factors associated with self-reported unmet need for medical care and prescriptions, as well as access delays. Patients with lower physical and mental health status had the highest odds of experiencing unmet need for medical care and prescriptions, as well as access delays. These findings highlight the importance of increasing access to a usual source of care among individuals with lower self-rated mental health status as a strategy for addressing unmet need.
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DeJonckheere M, Zhao A, Lane J, Plegue MA, Ranalli L, Wagner E, Riley M. Results of a National Text Message Poll of Youth: Perspectives on Primary Care. J Adolesc Health 2020; 67:814-820. [PMID: 32620346 DOI: 10.1016/j.jadohealth.2020.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE There is a significant interest in improving adolescent access to primary care, yet limited attempts to incorporate youth feedback within these efforts. The purpose of this study was to describe the experiences related to primary care among a large national sample of adolescents to improve patient-centered care. METHODS Youth were sent open-ended text message prompts via an ongoing study of 14- to 24-year-olds in the U.S. Text responses were analyzed using qualitative thematic analysis, including descriptive coding, consensus building, and theme development. Secondary quantitative analyses were conducted to determine differences by demographics. RESULTS Of 1,123 eligible participants, 789 (70.2%) responded to at least one prompt. Four themes were developed: (1) youth recognized the importance of primary care, but barriers exist that limited their utilization; (2) youth felt that improving convenience would increase the use of primary care; (3) youth were unsure how to transition between primary care settings; and (4) feeling respected was essential to youth having positive experiences in a primary care health care setting. Older youth and those identifying as female, nonbinary, or transgender were more likely to report previous bad experiences with primary care. CONCLUSIONS Our findings describe barriers and possible solutions to primary care among youth. Because attitudes toward health and health care are established during adolescence, a transformation is needed to create more patient-centered care that aligns with young people's values and experiences. Thus, primary care providers have the opportunity to positively impact the health of young people today and the adults of the future.
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Affiliation(s)
| | - Aisling Zhao
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
| | - Jenni Lane
- Adolescent Health Initiative, University of Michigan, Ann Arbor, Michigan
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lauren Ranalli
- Adolescent Health Initiative, University of Michigan, Ann Arbor, Michigan
| | - Ellen Wagner
- Adolescent Health Initiative, University of Michigan, Ann Arbor, Michigan
| | - Margaret Riley
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Adolescent Health Initiative, University of Michigan, Ann Arbor, Michigan
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Hardin HK, Alchami H, Lee D, Jones MS. Unmet health need and perceived barriers to health care among adolescents living in a rural area. CHILDRENS HEALTH CARE 2020; 50:108-123. [PMID: 33424079 PMCID: PMC7787257 DOI: 10.1080/02739615.2020.1833333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study investigated the perceived health care needs, unmet health need, and barriers to health care in 224 rural-dwelling adolescents. A cross-sectional, descriptive design was used to survey adolescents attending a public high school in a low-resource, rural Indiana community. One in five adolescents reported an unmet health need. The most common barriers to health care were related to access, apathy, anxiety, and parenting issues. Implications include confidentiality protocols in family healthcare practices, school-based health centers, and intervention research targeting adolescents' communication skills and healthcare consumer skills.
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Affiliation(s)
- Heather K. Hardin
- Case Western Reserve University, Frances Payne Bolton School of Nursing
| | - Hana Alchami
- Case Western Reserve University, Frances Payne Bolton School of Nursing
| | - David Lee
- Case Western Reserve University, Frances Payne Bolton School of Nursing
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38
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Baek S, Choi EH, Lee J. Unmet Healthcare Needs of Children in Vulnerable Families in South Korea: Finding from the Community Child Center Child Panel Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218241. [PMID: 33171882 PMCID: PMC7664643 DOI: 10.3390/ijerph17218241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
Presented in this paper is a study that examined the status of unmet healthcare needs of children in vulnerable families and identified factors affecting such unmet needs. The Community Child Center (CCC) Child Panel Survey data in Korea were used. A multiple stepwise logistic regression analysis was performed to examine factors influencing unmet healthcare needs of children. Influencing factors comprised predisposing, enabling, and need factors based on the Andersen Behavioral Model of Health Services Utilization. A total of 340 sixth-graders from vulnerable families participated, and 96 (28.2%) children had unmet healthcare needs. Factors included absence of an after-school caregiver (OR = 1.95, 95% CI [1.16, 3.27]), perceived physical symptoms (OR = 1.33, 95% CI [1.02, 1.73]), parental indifference (OR = 1.33, 95% CI [1.002, 1.77]), duration of daily stay at CCCs (OR = 1.32, 95% CI [1.01, 1.71]), and satisfaction with CCC teachers (OR = 0.65, 95% CI [0.49, 0.85]). The relationship with parents and CCC teachers had the strongest influence on unmet healthcare needs of children. In order to reduce the unmet healthcare needs of children in vulnerable families, existing support structures should be expanded to offer financial and administrative support for children’s parents and CCC teachers.
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Affiliation(s)
- Suyon Baek
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju-si 32588, Korea;
| | - Eun-Hi Choi
- College of Nursing, Eulji University, Daejeon 34824, Korea
- Correspondence:
| | - Jungeun Lee
- College of Nursing, University of Rhode Island, Kingston, RI 02881, USA;
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Huang Y, Heflin CM, Validova A. Material hardship, perceived stress, and health in early adulthood. Ann Epidemiol 2020; 53:69-75.e3. [PMID: 32949721 PMCID: PMC7494502 DOI: 10.1016/j.annepidem.2020.08.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 12/17/2022]
Abstract
Purpose We examined the associations between material hardship and health outcomes in early adulthood and the extent to which these associations are mediated by perceived stress. Methods We used wave I and IV of the National Longitudinal Study of Adolescent Health, a nationally representative survey of young adults aged 18–34 years old (n = 13,313). Multivariate logistic regression and decomposition methods were used to evaluate the associations between types and depth of material hardship (food, bill-paying, and health resource hardship), health outcomes (self-rated health, depression, sleep problems, and suicidal thoughts) in early adulthood, and the extent to which these associations were mediated by perceived stress. Results The adjusted odds of fair or poor health status, depression, sleep problems, and suicidal thoughts were higher among individuals with material hardship than counterparts without. A considerable proportion of the association between material hardship and health outcomes was attributable to perceived stress. Conclusions Material hardship is associated with adverse health outcomes in early adulthood, and these relationships are robust after accounting for various sociodemographic characteristics and family background. Perceived stress accounted for a sizable portion of the effects of material hardship on health. Public Health Implications Efforts to promote health equity in young adults should focus on material hardship and associated stressful conditions.
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Affiliation(s)
- Ying Huang
- Department of Demography, University of Texas at San Antonio, San Antonio.
| | - Colleen M Heflin
- Maxwell School of Public Affairs and Citizenship, Syracuse University, Syracuse, NY
| | - Asiya Validova
- Department of Demography, University of Texas at San Antonio, San Antonio
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40
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Dax V, Edwards N, Doidge O, Morkunas B, Thompson K, Lewin J. Evaluation of an Educational and Vocational Service for Adolescent and Young Adults with Cancer: A Retrospective Review. J Adolesc Young Adult Oncol 2020; 10:56-65. [PMID: 32392441 DOI: 10.1089/jayao.2020.0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Purpose: A cancer diagnosis and its treatment has the potential to interfere with the ability of adolescent and young adults (AYAs) to remain engaged in education or employment, placing social connectivity, career progression, and financial security at risk. This study aimed at assessing the educational and vocational outcomes of AYAs supported by an Education and Vocational Support Program (EVSP). Methods: Consecutive case files were reviewed of AYAs accessing the EVSP at ONTrac at Peter Mac (January 2014-December 2016). Data collected included: demographic information; diagnosis and treatment; referral time point; education/employment status at referral and end of treatment; and interventions provided. Results: Two hundred nineteen AYAs had >1 appointment with an EVSP advisor. The mean age was 19.6 (13-26). The most common intervention delivered was direct consultations. Overall, 79% of AYAs were engaged in educational and/or vocational pursuits at last known status. Engagement with EVSP during treatment for employment and tertiary educational support had a high rate of attendance at last known status (during treatment: 93% and 92.5%; post-treatment: 71% and 69%, respectively). At referral to EVSP, 27 AYAs were not in education, employment, or training; however, >50% re-integrated in employment or study after EVSP support. Conclusion: This is the first study to describe the role of an EVSP for Australian AYAs. With the support of an EVSP, the vast majority of AYAs remained engaged in education and/or employment throughout their cancer trajectory. Further research will be required to evaluate the quality of interventions and incorporate the voice of AYAs to further inform service delivery.
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Affiliation(s)
- Victoria Dax
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicole Edwards
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Olivia Doidge
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Bryce Morkunas
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Social Work and The University of Melbourne, Melbourne, Australia
| | - Jeremy Lewin
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
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41
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Affiliation(s)
- Paritosh Kaul
- Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado; and
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42
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The UK's global standing in child and young people's health and how GPs can help. Br J Gen Pract 2020; 70:156-157. [PMID: 32217569 DOI: 10.3399/bjgp20x708905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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43
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A Weight Management Program Within a High School Health Center. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2019.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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44
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Arauz-Boudreau A, Riobueno-Naylor A, Haile H, Holcomb JM, Lucke CM, Joseph B, Jellinek MS, Murphy JM. How an Electronic Medical Record System Facilitates and Demonstrates Effective Psychosocial Screening in Pediatric Primary Care. Clin Pediatr (Phila) 2020; 59:154-162. [PMID: 31808350 DOI: 10.1177/0009922819892038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Using questionnaires, administrative claims, and chart review data, the current study explored the impact of using an electronic medical record system to administer, score, and store the Pediatric Symptom Checklist (PSC-17) during annual pediatric well-child visits. Within a sample of 1773 Medicaid-insured outpatients, the electronic system demonstrated that 90.5% of cases completed a PSC-17 screen electronically, billing codes indicating a screen was administered agreed with the existence of a questionnaire in the chart in 98.8% of cases, the classification of risk based on PSC-17 scores agreed with the classification of risk based on the Current Procedural Terminology code modifiers in 72.9% of cases, and 90.0% of clinicians' progress notes mentioned PSC-17 score in treatment planning. Using an electronic approach to psychosocial screening in pediatrics facilitated the use of screening information gathered during the clinical visit and allowed for enhanced tracking of outcomes and quality monitoring.
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Affiliation(s)
- Alexy Arauz-Boudreau
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Michael S Jellinek
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - J Michael Murphy
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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45
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Brown C, Frohard-Dourlent H, Wood BA, Saewyc E, Eisenberg ME, Porta CM. "It makes such a difference": An examination of how LGBTQ youth talk about personal gender pronouns. J Am Assoc Nurse Pract 2020; 32:70-80. [PMID: 31232865 DOI: 10.1097/jxx.0000000000000217] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE The World Health Organization has developed standards for youth-friendly health services to support adolescents and encourage health care utilization among youth. Necessary building blocks for youth-friendly care include strong interpersonal relationships between youth and health care providers. Nurse practitioners (NPs) may be particularly well positioned to form these relationships. This study explored a core aspect for building youth-provider relationships. The study examined how lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents discussed use of personal pronouns (e.g., he, she, they, ze) in relation to transgender and gender diverse (TGD) people. METHODS A secondary qualitative analysis of 66 in-depth interviews with LGBTQ youth from across Minnesota, Massachusetts, and British Columbia, Canada was conducted. Results were sorted into four main themes describing different aspects of personal pronoun use as related to TGD individuals. CONCLUSIONS Stories and experiences shared by participants illustrate how to assess which pronouns to use for a given person, how to use pronouns in different contexts, why respecting pronouns is important to TGD people, and flexibility as an integral component of the learning process when it comes to appropriate pronoun use. IMPLICATIONS FOR PRACTICE Understanding how youth discuss personal pronouns could improve practice with TGD youth. Each of the four themes can be applied to clinical encounters to ensure culturally sensitive care. Practice recommendations include asking adolescents what pronouns they prefer clinic staff to use on intake forms and having NPs and clinic staff provide their own pronouns to patients in introductions.
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Affiliation(s)
- Camille Brown
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | | | - Brittany A Wood
- Graduate School of Public Health and Institute for Behavioral and Community Health, San Diego State University, San Diego, California
| | - Elizabeth Saewyc
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marla E Eisenberg
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
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Abstract
Adolescence is the transitional bridge between childhood and adulthood; it encompasses developmental milestones that are unique to this age group. Healthy cognitive, physical, sexual, and psychosocial development is both a right and a responsibility that must be guaranteed for all adolescents to successfully enter adulthood. There is consensus among national and international organizations that the unique needs of adolescents must be addressed and promoted to ensure the health of all adolescents. This policy statement outlines the special health challenges that adolescents face on their journey and transition to adulthood and provides recommendations for those who care for adolescents, their families, and the communities in which they live.
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Affiliation(s)
- Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York; and
| | - Cora C Breuner
- Division of Adolescent Medicine, Departments of Pediatrics and Orthopedics and Sports Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
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47
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Newcomb ME, Moran K, Li DH, Mustanski B. Demographic, Regional, and Political Influences on the Sexual Health Care Experiences of Adolescent Sexual Minority Men. LGBT Health 2019; 7:28-36. [PMID: 31750760 DOI: 10.1089/lgbt.2019.0122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescent sexual minority men (ASMM) are affected disproportionately by HIV, and little is known about their utilization of sexual health care services. We aimed to examine demographic, regional, and political influences on the sexual health care experiences of a unique sample of racially diverse ASMM from across the United States. Methods: Data were collected between April 2018 and February 2019 as part of the baseline survey of an ongoing pragmatic trial of a suite of HIV prevention interventions for ASMM. At the time of analysis, 699 participants had completed baseline and were included in multivariable analyses examining demographic, regional, and political differences in perceived access to and experiences of sexual health care. Results: The majority of ASMM reported not having had various sexual health care experiences in the past 12 months (70.8%-85.7%, respectively), and a large proportion reported low-to-moderate perceived access to such services where they live (37.8%-64.1%, respectively). Some groups were significantly less likely to report perceived access to, or having had, certain sexual health care experiences, including ASMM in their early- to mid-teens and those who lived in rural areas, the South, and Republican state-level political climates. Conclusion: These analyses indicate that ASMM underutilize sexual health care and point to specific groups with the lowest rates of engagement. To address the sexual health needs of ASMM, structural changes need to be made in the sociopolitical arena (e.g., federal nondiscrimination legislation) and medical system (e.g., mandated training in LGBTQ care) that will reduce LGBTQ-related stigma and increase access to needed care.
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Affiliation(s)
- Michael E Newcomb
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kevin Moran
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dennis H Li
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brian Mustanski
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Ghafari M, Bahadivand-Chegini S, Nadi T, Doosti-Irani A. The global prevalence of dental healthcare needs and unmet dental needs among adolescents: a systematic review and meta-analysis. Epidemiol Health 2019; 41:e2019046. [PMID: 31778605 PMCID: PMC6883027 DOI: 10.4178/epih.e2019046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/27/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Access to dental healthcare services is a major determinant of dental health in communities. This meta-analysis was conducted to estimate the global prevalence of dental needs and of unmet dental needs in adolescents. METHODS PubMed, Web of Science, and Scopus were searched in June 2018. The summary measures included the prevalence of met and unmet dental needs. A meta-analysis was performed using the inverse variance method to obtain pooled summary measures. Out of 41,661 retrieved articles, 57 were ultimately included. RESULTS The pooled prevalence of orthodontic treatment needs was 46.0% (95% confidence interval [CI], 38.0 to 53.0), that of general treatment needs was 59.0% (95% CI, 42.0 to 75.0), that of periodontal treatment needs was 71.0% (95% CI, 46.0 to 96.0), and that of malocclusion treatment needs was 39.0% (95% CI, 28.0 to 50.0). The pooled prevalence of unmet dental needs was 34.0% (95% CI, 27.0 to 40.0). CONCLUSIONS The highest and lowest prevalence of unmet dental needs were found in Southeast Asia and Europe, respectively. The prevalence of dental needs was higher in the countries of the Americas and Europe than in other World Health Organization (WHO) regions. The prevalence of unmet dental needs was higher in Southeast Asia and Africa than in other WHO regions.
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Affiliation(s)
- Mahin Ghafari
- Department of Public Health, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Samira Bahadivand-Chegini
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Tayebeh Nadi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amin Doosti-Irani
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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49
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Hargreaves DS, Arora S, Viveiro C, Hale DR, Ward JL, Sherlaw-Johnson C, Viner RM, Dunkley C, Cross JH. Association of quality of paediatric epilepsy care with mortality and unplanned hospital admissions among children and young people with epilepsy in England: a national longitudinal data linkage study. THE LANCET. CHILD & ADOLESCENT HEALTH 2019; 3:627-635. [PMID: 31281027 DOI: 10.1016/s2352-4642(19)30201-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/28/2019] [Accepted: 05/03/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Concerns have been raised about variation in care quality and outcomes among children and young people with epilepsies in England. We aimed to investigate the association between quality of paediatric care, hospital admissions, and all-cause deaths among epilepsy patients. METHODS In this longitudinal data linkage study of paediatric epilepsy services in England, we linked unit-level data from round 1 (2009-11) and round 2 (2013-14) of the Epilepsy12 national clinical audit, with death registrations from the UK Office for National Statistics and data for unplanned hospital admissions from Hospital Episode Statistics. We investigated the association between unit-level performance in involving a paediatrician with epilepsy expertise, an epilepsy specialist nurse, and a paediatric neurologist (where appropriate) in round 1 and the proportion of adolescents (aged 10-18 years) with epilepsy admitted to each unit who subsequently died during the study period (April 1, 2009, to March 31, 2015). We also investigated whether change in Epilepsy12 performance between the two audit rounds was associated with changes in the standardised ratio of observed-to-expected unplanned epilepsy admissions over the same period. FINDINGS In 99 units with data for the analyses relating to paediatricians with epilepsy expertise and epilepsy specialist nurses, 134 (7%) of 1795 patients died during the study period, 88 (5%) of whom died after the transition to adult service. In 55 units with data for the analyses relating to paediatric neurologists, 79 (7%) of 1164 patients died, 54 (5%) of whom did so after the transition. In regression models adjusting for population, unit, and hospital activity characteristics, absolute reductions in total mortality risk (6·4 percentage points, 95% CI 0·1-12·7) and mortality risk after transition (5·7 percentage points, 0·6-10·8) were found when comparing units where all versus no eligible patients were seen by a paediatric neurologist. Units where all eligible patients were seen by a paediatric neurologist were estimated to have absolute reductions of 4·6 percentage points (0·3-8·9) in total mortality and of 4·6 percentage points (1·2-8·0) in post-transition mortality, compared with units where no or some eligible patients were seen by a paediatric neurologist. There was no significant association between performance on being seen by an epilepsy specialist nurse or by a paediatrician with epilepsy expertise and mortality. In units where access to an epilepsy specialist nurse decreased, the standardised ratio of epilepsy admissions increased by a mean of 0·21 (0·01-0·42). INTERPRETATION Among adolescents with epilepsy, greater involvement of tertiary specialists in paediatric care is associated with decreased all-cause mortality in the period after transition to adult services. Reduced access to an epilepsy specialist nurse was associated with an increase in paediatric epilepsy admissions. FUNDING The Health Foundation.
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Affiliation(s)
- Dougal S Hargreaves
- Department of Primary Care & Public Health, Imperial College London, London, UK; Nuffield Trust, London, UK.
| | - Sandeepa Arora
- Department of Primary Care & Public Health, Imperial College London, London, UK; Nuffield Trust, London, UK
| | | | - Daniel R Hale
- Department of Psychology, Heriot Watt University, Edinburgh, UK
| | - Joseph L Ward
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Russell M Viner
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Colin Dunkley
- Sherwood Forest Hospitals NHS Foundation Trust, Sutton In Ashfield, UK
| | - J Helen Cross
- UCL Great Ormond Street Institute of Child Health, London, UK
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50
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Aeschbach CJ, Burrough WB, Olejniczak AB, Koepsel ER. Teaching Adolescents to Manage Their Own Health Care. J Sch Nurs 2019; 37:404-411. [PMID: 31426712 DOI: 10.1177/1059840519867363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Many factors impact an adolescent's willingness to appropriately use health-care services and intent to begin the health-care transition process. Published literature continues to show that the way adolescents experience and utilize health-care services is ineffective and has long-term impacts on individuals and systems. Building upon the success of an existing peer-to-peer workshop, a Toolkit was created to provide school-based health professionals the information and resources needed to deliver pertinent information to high school students in one lesson. Of 416 students, over two thirds reported that they plan to be more involved in their health care (69.8%), advocate for themselves in health-care settings (68.0%), talk openly and honestly with health-care providers (71.9%), and learn more about managing their own health care (68.6%). Integrating this information into existing health curricula provided a broader reach with minimal work and promising results that could improve overall health-care transition efforts.
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Affiliation(s)
- Chelsea J Aeschbach
- Providers and Teens Communicating for Health (PATCH) Program, Wisconsin Alliance for Women's Health, Madison, WI, USA
| | - William B Burrough
- Benioff Children's Hospital, University of California San Francisco, Oakland, CA, USA.,School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Amy B Olejniczak
- Providers and Teens Communicating for Health (PATCH) Program, Wisconsin Alliance for Women's Health, Madison, WI, USA
| | - Erica R Koepsel
- Providers and Teens Communicating for Health (PATCH) Program, Wisconsin Alliance for Women's Health, Madison, WI, USA
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