Influence of Motor Imagery Modality on First-Serve Performance in Tennis Players

Motor imagery (MI) is frequently used in tennis players. This pilot study aimed to assess whether the MI modality and preference of skilled tennis players could influence their service performance when using MI before serving first balls. Twenty expert players (Mage = 18.6 years) completed the movement imagery questionnaire (third version) to assess their MI modality scores (internal visual, external visual, and kinesthetic) and their MI preference. Participants completed 4 experimental counterbalanced sessions spread over 4 weeks, each including the completion of 20 first-serve balls in match condition. The sessions included a control condition (i.e., only physical practice trials) and three MI conditions during which the players had to mentally imagine themselves performing a serve according to one of the imagery modalities, either internal visual, external visual, or kinesthetic, before serving. The percentage of success, the speed of the service balls (measured by a tablet with SWING VISION and a radar gun), and an efficiency score were recorded and then evaluated by experts and served as performance indicators and dependent variables. The results of this study showed that players benefited from MI before serving and that almost a third of the participants achieved a higher percentage of success and efficiency scores when using their preferred MI modality. These results lead us, in an applied way, to suggest to skilled tennis players to determine their MI preference and to have recourse to the mental simulation of a successful serve before serving the first balls in match condition.

Common reasons for non-participation during the outcome measurement process: wheeled mobility service delivery quality improvement reporting

OBJECTIVE

The purpose of this paper is to describe non-participation during the outcome measurement step of the wheeled mobility service delivery process (WMSDP) based on the Functional Mobility Assessment (FMA)-Uniform Dataset (UDS) Registry.

INTRODUCTION

The WMSDP is a standard framework for the provision of wheeled mobility devices, and several factors influence the client's experience throughout the process. Patient-reported outcomes are one way to measure the client's experience as part of a quality improvement program.

METHODS

A retrospective descriptive study was conducted on the FMA-UDS Registry to measure the response rate during the outcome measurement step of the WMSDP and describe the reasons an individual did not complete the FMA-UDS. The FMA-UDS was examined at two time points: pre-delivery and post-delivery of the wheeled mobility device.

RESULTS

As of September 2, 2021, 10,253 cases have been entered into the FMA-UDS Registry. 2,247 cases were no longer participating pre-delivery, and an additional 3,905 cases were no longer participating post-delivery. The most common reasons for non-participation in the FMA-UDS pre-delivery and post-delivery included: equipment not delivered; provider no longer participating in the FMA-UDS; funding issues; no new equipment; client opted out; loss in contact; deceased; returned equipment; and other.

DISCUSSION

The type and frequency of non-participation in the outcome measurement step of the WMSDP is critical to understanding why individuals participate in outcome measures and provides insight into the barriers and facilitators for the implementation of quality improvement programs.

The attitudes of nurses towards seclusion: A New Zealand in-patient mental health setting

Seclusion is a form of restraint practised in mental health services world-wide, and has been criticised as unethical and traumatising to patients. Several countries have committed to reducing or eliminating seclusion. In New Zealand, there has been a focus on reducing seclusion of the indigenous Māori population, who experience particularly high rates. Nurses typically lead decisions to place patients in seclusion and their attitudes towards seclusion likely influence this process. This study aimed to address the primary question: what are the attitudes of registered nurses towards the use of seclusion? A mixed methods pragmatic approach was used involving qualitative interviews of nurses working in a high seclusion mental health ward located in the North Island of New Zealand, and a quantitative analysis of the seclusion data from this ward. This report is adherent with COREQ and STROBE. Thirteen nurses were interviewed and four main themes were identified: seclusion is necessary; seclusion is being used unnecessarily; nurse characteristics influence the use of seclusion; nurses perceived their ward culture to be improving in the use of seclusion. However, analysis of seclusion data indicated that rates had been increasing for this ward prior to this study, and the rates for indigenous Māori patients were especially elevated. This pattern of increasing rates was congruent with the 'supportive' attitudes of nurses towards seclusion. Interestingly, during the time of this study, the seclusion rates began to decline, including for Māori patients. This decline may have been partially due to the increased awareness prompted by the study.

Barriers to mental health service utilisation among medical students in Saudi Arabia

Introduction

Medical students experience high levels of stress, often due to academic demands, which can adversely affect their mental health. However, they frequently hesitate to seek and underutilise available mental health services. This study aimed to assess the perceived need for mental health services and identify the barriers to seeking help among undergraduate medical students.

Materials and methods

This cross-sectional study recruited 480 undergraduate medical students from two main universities in the Eastern Province of Saudi Arabia. Data were collected through an online, self-administered questionnaire that encompassed sections on sociodemographic details, the Patient Health Questionnaire (PHQ-9), perceptions about the necessity for professional mental health care, service utilisation over the past year, and the Barriers to Access to Care Evaluation (BACE-III).

Results

The study found that 33.6% of the participants showed signs of depression. Even though 42.5% expressed a perceived need for mental health services, only 16.2% actually utilised these services in the previous 12 months. In terms of barriers, attitudinal-related barriers received the highest mean score, followed by stigma- and instrumental-related barriers. Notably, students who had previously experienced academic failure and those who had sought mental health services were more inclined to report stigma- and instrumental-related barriers.

Conclusion

Mental health challenges are notably prevalent among undergraduate medical students. Although there is a significant perceived need for professional mental health intervention, the actual utilisation rate remains low. The primary obstacles to seeking assistance are attitudinal and stigma-related barriers.

The Urgent Need for an Evidence-Based Digital Mental Health Practice Model of Care for Youth

Australian providers of mental health services and support for young people include private and public allied health providers, government initiatives (eg, headspace), nongovernment organizations (eg, Kids Helpline), general practitioners (GPs), and the hospital system. Over 20 years of research has established that many young people prefer to seek mental health support online; however, clear client pathways within and between online and offline mental health services are currently lacking. The authors propose a Digital Mental Health Practice model of care for youth to assist with digital mental health service mapping. The proposed model offers accessible pathways for a client to engage with digital mental health services, provides clear navigation to access support for individual needs, and facilitates a seamless connection with offline mental health services using a transferable electronic health records system. This future-looking model also includes emerging technologies, such as artificial intelligence and the metaverse, which must be accounted for as potential tools to be leveraged for digital therapies and support systems. The urgent need for a user-centered Digital Mental Health Practice model of care for youth in Australia is discussed, highlighting the shortcomings of traditional and existing online triage models evident during the COVID-19 pandemic, and the complex challenges that must be overcome, such as the integration of diverse mental health care providers and establishment of a robust electronic health records system. Potential benefits of such a model include reduced pressure on emergency rooms, improved identification of immediate needs, enhanced referral practices, and the establishment of a cost-efficient national digital mental health care model with global applicability. The authors conclude by stressing the consequences of inaction, warning that delays may lead to more complex challenges as new technologies emerge and exacerbate the long-term negative consequences of poor mental health management on the economic and biopsychosocial well-being of young Australians.

Preliminary Evidence of the Use of Generative AI in Health Care Clinical Services: Systematic Narrative Review

BACKGROUND

Generative artificial intelligence tools and applications (GenAI) are being increasingly used in health care. Physicians, specialists, and other providers have started primarily using GenAI as an aid or tool to gather knowledge, provide information, train, or generate suggestive dialogue between physicians and patients or between physicians and patients' families or friends. However, unless the use of GenAI is oriented to be helpful in clinical service encounters that can improve the accuracy of diagnosis, treatment, and patient outcomes, the expected potential will not be achieved. As adoption continues, it is essential to validate the effectiveness of the infusion of GenAI as an intelligent technology in service encounters to understand the gap in actual clinical service use of GenAI.

OBJECTIVE

This study synthesizes preliminary evidence on how GenAI assists, guides, and automates clinical service rendering and encounters in health care The review scope was limited to articles published in peer-reviewed medical journals.

METHODS

We screened and selected 0.38% (161/42,459) of articles published between January 1, 2020, and May 31, 2023, identified from PubMed. We followed the protocols outlined in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to select highly relevant studies with at least 1 element on clinical use, evaluation, and validation to provide evidence of GenAI use in clinical services. The articles were classified based on their relevance to clinical service functions or activities using the descriptive and analytical information presented in the articles.

RESULTS

Of 161 articles, 141 (87.6%) reported using GenAI to assist services through knowledge access, collation, and filtering. GenAI was used for disease detection (19/161, 11.8%), diagnosis (14/161, 8.7%), and screening processes (12/161, 7.5%) in the areas of radiology (17/161, 10.6%), cardiology (12/161, 7.5%), gastrointestinal medicine (4/161, 2.5%), and diabetes (6/161, 3.7%). The literature synthesis in this study suggests that GenAI is mainly used for diagnostic processes, improvement of diagnosis accuracy, and screening and diagnostic purposes using knowledge access. Although this solves the problem of knowledge access and may improve diagnostic accuracy, it is oriented toward higher value creation in health care.

CONCLUSIONS

GenAI informs rather than assisting or automating clinical service functions in health care. There is potential in clinical service, but it has yet to be actualized for GenAI. More clinical service-level evidence that GenAI is used to streamline some functions or provides more automated help than only information retrieval is needed. To transform health care as purported, more studies related to GenAI applications must automate and guide human-performed services and keep up with the optimism that forward-thinking health care organizations will take advantage of GenAI.

Patients' and caregivers' perceptions of the quality of hospital-at-home service: A scoping review

AIM

This scoping review aims to provide an overview of patients and caregivers perceptions of hospital-at-home (HaH) services.

BACKGROUND

HaH services provide patients with hospital-level care at home and are central to integrated healthcare systems. Despite favourable data from individual studies in the literature, in-depth analysis from patient and caregivers perspectives is lacking. This understanding is essential for the dissemination and scaling of HaH services.

DESIGN

The scoping review was performed using the PRISMA-ScR checklist and PAGER framework for the findings report and research recommendations.

METHOD

Literature from PubMed, Web of Science, Ovid, CINAHL, Cochrane and Mednar databases were searched. Relevant studies published between 1st January 2005 and 31st December 2022 were identified. The conceptual model of the development of patient perceptions of quality was used for data extraction and tabulation.

RESULTS

The review included 24 articles. Expectation attributions were identified as needs, types of service, hospitalisation experiences, family care preferences, social-demographics and coping skills. From patient's and caregiver's perspectives, HaH was safe, effective and viewed positively. Perceived concerns/barriers and enablers/facilitators were associated with individual, caregiver and system factors, but demonstrated an overall satisfaction in the HaH service.

CONCLUSION

HaH provides an excellent service according to patients' and caregivers' perceptions. However, gaps in care were identified such as prioritising patient-centred care, along with improved multidisciplinary continuity of care and future studies should incorporate these into their research of HaH.

RELEVANCE TO CLINICAL PRACTICE

Patients' and caregivers' HaH needs should be embedded in the design, development and implementation of HaH services.

PATIENT AND PUBLIC CONTRIBUTION

Not applicable for the study design of this scoping review.

A Multisource Process Evaluation of a Community-Based Healthy Lifestyle Programme for Child and Adolescent Obesity

Whānau Pakari is a healthy lifestyle assessment and intervention programme for children and adolescents with obesity in Taranaki (Aotearoa/New Zealand), which, in this region, replaced the nationally funded Green Prescription Active Families (GRxAF) programme. We compared national referral rates from the GRxAF programme (age 5-15 years) and the B4 School Check (B4SC, a national preschool health and development assessment) with referral rates in Taranaki from Whānau Pakari. We retrospectively analysed 5 years of clinical data (2010-2015), comparing referral rates before, during, and after the Whānau Pakari clinical trial, which was embedded within the programme. We also surveyed programme referrers and stakeholders about their experiences of Whānau Pakari, analysing their responses using a multiple-methods framework. After the Whānau Pakari trial commenced, Taranaki GRxAF referral rates increased markedly (2.3 pretrial to 7.2 per 1000 person-years), while NZ rates were largely unchanged (1.8-1.9 per 1000 person-years) (p < 0.0001 for differences during the trial). Post-trial, Taranaki GRxAF referral rates remained higher irrespective of ethnicity, being 1.8 to 3.2 times the national rates (p < 0.001). Taranaki B4SC referrals for obesity were nearly complete at 99% in the last trial year and 100% post-trial, compared with national rates threefold lower (31% and 32%, respectively; p < 0.0001), with Taranaki referral rates for extreme obesity sustained at 80% and exceeding national rates for both periods (58% and 62%, respectively; p < 0.01). Notably, a referral was 50% more likely for referrers who attended a Whānau Pakari training half-day (RR = 1.51; p = 0.009). Stakeholders credited the success of Whānau Pakari to its multidisciplinary team, family-centred approach, and home-based assessments. However, they highlighted challenges such as navigating multidisciplinary collaboration, engaging with families with complex needs, and shifting conventional healthcare practices. Given its favourable referral trends and stakeholder endorsement, Whānau Pakari appears to be a viable contemporary model for an accessible and culturally appropriate intervention on a national and potentially international scale.

A Digital Respiratory Ward in Leicester, Leicestershire, and Rutland, England, for Patients With COVID-19: Economic Evaluation of the Impact on Acute Capacity and Wider National Health Service Resource Use

BACKGROUND

The COVID-19 pandemic stressed global health care systems' acute capacity and caused a diversion of resources from elective care to the treatment of acute respiratory disease. In preparing for a second wave of COVID-19 infections, England's National Health Service (NHS) in Leicester, Leicestershire, and Rutland sought to protect acute capacity in the winter of 2020-2021. Their plans included the introduction of a digital ward where patients were discharged home early and supported remotely by community-based respiratory specialists, who were informed about patient health status by a digital patient monitoring system.

OBJECTIVE

The objective of the digital ward was to maintain acute capacity through safe, early discharge of patients with COVID-19 respiratory disease. The study objective was to establish what impact this digital ward had on overall NHS resource use.

METHODS

There were no expected differences in patient outcomes. A cost minimization was performed to demonstrate the impact on the NHS resource use from discharging patients into a digital COVID-19 respiratory ward, compared to acute care length of stay (LOS). This evaluation included all 310 patients enrolled in the service from November 2020 (service commencement) to November 2021. Two primary methods, along with sensitivity analyses, were used to help overcome the uncertainty associated with the estimated comparators for the observational data on COVID-19 respiratory acute LOS, compared with the actual LOS of the 279 (90%) patients who were not discharged on oxygen nor were in critical care. Historic comparative LOS and an ordinary least squares model based on local monthly COVID-19 respiratory median LOS were used as comparators. Actual comparator data were sourced for the 31 (10%) patients who were discharged home and into the digital ward for oxygen weaning. Resource use associated with delivering care in the digital ward was sourced from the digital system and respiratory specialists.

RESULTS

In the base case, the digital ward delivered estimated health care system savings of 846.5 bed-days and US $504,197 in net financial savings across the 2 key groups of patients-those on oxygen and those not on oxygen at acute discharge (both P<.001). The mean gross and net savings per patient were US $1850 and US $1626 in the base case, respectively, without including any savings associated with a potential reduction in readmissions. The 30-day readmission rate was 2.9%, which was below comparative data. The mean cost of the intervention was US $223.53 per patient, 12.1% of the estimated gross savings. It was not until the costs were increased and the effect reduced simultaneously by 78.4% in the sensitivity analysis that the intervention was no longer cost saving.

CONCLUSIONS

The digital ward delivered increased capacity and substantial financial savings and did so with a high degree of confidence, at a very low absolute and relative cost.

Designing a Web-Based Navigation Tool to Support Access to Youth Mental Health Services: Qualitative Study

BACKGROUND

Many young people with mental health problems do not readily seek help or receive treatment and support. One way to address low help-seeking behavior is to improve access to information on mental health services and how to navigate the mental health system via a web-based tool. Seeking input from the end users (young people and parents or caregivers) on key features of the tool is imperative to ensure that it is relevant, engaging, and likely to meet their needs and expectations.

OBJECTIVE

This study aims to investigate young person and parent or caregiver views on the design, content, functioning, and user experience of a web-based mental health navigation tool to support connection to mental health services for children and young people aged up to 25 years.

METHODS

A total of 4 online focus groups were conducted: 2 with young people aged 16 years and older (total n=15) and 2 with parents or caregivers (total n=13). Focus groups were structured around a series of guiding questions to explore participants' views on content, features, user experience, and design of a mental health navigation website. Focus groups were audio recorded with detailed notes taken. In addition, 53 young people aged 16-25 years and 97 parents or caregivers completed an online survey, comprising closed- and open-ended questions; open-ended responses were included with the focus group data in the qualitative analysis. All qualitative data were analyzed using thematic analysis.

RESULTS

A total of 2 topic areas and 7 themes were developed. The first topic area covered the types of information needs of young people and parents. Identified themes concerned the scope of the navigation website, as well as the provision of up-to-date and practical information on how to navigate the whole help-seeking process. The second topic area covered website features that would be beneficial and included the consideration of the website design; search engines; supported navigation; and forums, reviews, and user accounts.

CONCLUSIONS

This study provides important insights into the navigation needs of young people and parents or caregivers in seeking mental health services. Key findings identified through this research have directly informed the development of MindMap, a web-based youth navigation tool providing a searchable database of local services, including a clear description, their location, and potential wait times. The website can be navigated independently or with support.

Comparative analysis of population growth and women employment patterns in agriculture and service sectors: Evidence from China and India

This study uses a comparative approach to investigate population growth patterns and women employment in two strategic sectors of China and India from 2005 to 2021. Consequently, a descriptive statistic was used to estimate the performance of each of the variables of interest. The results showed that the average mean value of population growth rate in China is 0.52 % while that of India is 1.23%. The mean value of women employed in agriculture in India is higher comparing to the average percentage of women in agriculture in China. Moreover, Chinese service sector accounts for 45.27% of female workforce but its India counterpart engages 21.71% of women working population. This implies that the Chinese service sector engages a significant proportion of the female working population. In the light of this, policymakers in India should prioritise investment in human development of the female population in order to ensure gender balancing in the service sector of the country. Also, the policymakers in India need to embark on a proactive measure in controlling its increasing population in order to ensure that the country's population growth rate does not overshoot the means of sustenance in the country.

The Effect of Remote Digital Services on Health Care Inequalities Among People Under Long-Term Dermatology Follow-Up: Cross-Sectional Questionnaire Study

BACKGROUND

Given the expansion of remote digital dermatology services from the National Health Service, particularly during the COVID-19 pandemic, there is a need for methods that identify patients at risk of digital exclusion to guide equitable representation in service co-design processes and tailor remote services to the needs of their patient population.

OBJECTIVE

This quality improvement project aims to inform the redesign of remote services to optimally support the ongoing needs of patients with chronic skin diseases, ensuring that the services are tailored to patients' digital health literacy requirements.

METHODS

We profiled the digital health literacy of 123 people with chronic skin conditions who require long-term surveillance in 2 specialist clinics (London, United Kingdom) using the Multidimensional Readiness and Enablement Index for Health Technology (READHY) questionnaire alongside the Optimizing Health Literacy and Access (Ophelia) process for hierarchical cluster analysis.

RESULTS

The cluster analysis of READHY dimensions in responding participants (n=116) revealed 7 groups with distinct digital and health literacy characteristics. High READHY scores in groups 1 (n=22, 19%) and 2 (n=20, 17.2%) represent those who are confident with managing their health and using technology, whereas the lower-scoring groups, 6 (n=4, 3.4%) and 7 (n=12, 10.3%), depended on traditional services. Groups 3 (n=27, 23.3%), 4 (n=23, 19.8%), and 5 (n=8, 6.9%) had varying digital skills, access, and engagement, highlighting a population that may benefit from a co-designed dermatology service.

CONCLUSIONS

By identifying patient groups with distinguishable patterns of digital access and health literacy, our method demonstrates that 63.8% (n=74) of people attending specialist clinics in our center require support in order to optimize remote follow-up or need an alternative approach. Future efforts should streamline the READHY question profile to improve its practicality and use focus groups to elicit strategies for engaging patients with digital services.

Implementing Telemedicine in Clinical Practice in the First Digital Hematology Unit: Feasibility Study

BACKGROUND

Currently, there are no telemedicine models that fully integrate all areas of hematology into daily practice.

OBJECTIVE

The objectives of this feasibility study were to assess the practicality of implementing telemedicine into our clinical practice in the first Digital Hematology Unit and propose an innovative integrative design for clinical practice.

METHODS

We designed the Digital Hematology Unit, which is a specific physical space dedicated to carrying out telemedicine and monitoring patients in a holistic way. Also, a satisfaction questionnaire was performed and health care indicators were measured.

RESULTS

In 2021, there were 1331 first visits and 7534 follow-up visits. Of the first visits, 12.2% (n=163) were face-to-face and 87.8% (n=1168) were telematic. For follow-up visits, 29.9% (n=2251) were face-to-face and 70.1% (n=5283) were telematic. The health care management indicators showed that we had a waiting time of less than 4 days and took less than 4 hours to answer interconsultations among specialists. Moreover, patients reported a high level of satisfaction with the services provided.

CONCLUSIONS

Our Digital Hematology Unit, as a case of success, serves as an example of how innovative digital solutions can contribute to the quality of care and excellence in health care achieved through a digital transformation process led by hematologists.

Experiences of lower limb prosthesis users in Kenya: a qualitative study to understand motivation to use and satisfaction with prosthetic outcomes

PURPOSE

To explore the personal and system factors that motivate and enhance outcomes for patients accessing a prosthetic service and using a lower-limb prosthesis within a low resource setting.

MATERIALS AND METHODS

This study employed a qualitative approach to explore the motivations and satisfaction of individuals with lower limb loss engaging with a prosthetic service in Mombasa, Kenya. In-depth interviews were conducted over Microsoft Teams with 10 lower limb prosthesis users and thematic analysis was applied.

RESULTS

Five key themes emerged: acceptance, self-determination, hope, clinician relationship and perception. These findings demonstrate the importance of hopeful thinking and a supportive community in overcoming physical and stigmatising challenges. The findings further highlight the value of the service provider relationship beyond just prescribing an assistive device.

CONCLUSION

These results have relevance in developing patient-centred services, assistive devices and personnel training that are responsive, motivating, and cognisant of the service user. This is of particular interest as assistive technology services are newly developed in low resource settings.IMPLICATIONS FOR REHABILITATIONThis research provides an understanding of lower-limb prosthesis users' satisfaction of a device and motivation for engaging with a prosthetic service within a low resource setting.The relationship the rehabilitation professional has with the service user plays a significant role in facilitating motivation during rehabilitation.Rehabilitation professionals should consider how they can foster a network of support amongst service users when planning services in remote, rural locations.Rehabilitation professionals should be aware of how hopeful thinking can be facilitated during rehabilitation to support motivation.When reviewing the success of services, or designing new service models, the service users should be consulted on what they would deem as a successful outcome.

Clinicians' Perspective on Implementing Virtual Hospital Care for Low Back Pain: Qualitative Study

BACKGROUND

Alternate "hospital avoidance" models of care are required to manage the increasing demand for acute inpatient beds. There is currently a knowledge gap regarding the perspectives of hospital clinicians on barriers and facilitators to a transition to virtual care for low back pain. We plan to implement a virtual hospital model of care called "Back@Home" and use qualitative interviews with stakeholders to develop and refine the model.

OBJECTIVE

We aim to explore clinicians' perspectives on a virtual hospital model of care for back pain (Back@Home) and identify barriers to and enablers of successful implementation of this model of care.

METHODS

We conducted semistructured interviews with 19 purposively sampled clinicians involved in the delivery of acute back pain care at 3 metropolitan hospitals. Interview data were analyzed using the Theoretical Domains Framework.

RESULTS

A total of 10 Theoretical Domains Framework domains were identified as important in understanding barriers and enablers to implementing virtual hospital care for musculoskeletal back pain. Key barriers to virtual hospital care included patient access to videoconferencing and reliable internet, language barriers, and difficulty building rapport. Barriers to avoiding admission included patient expectations, social isolation, comorbidities, and medicolegal concerns. Conversely, enablers of implementing a virtual hospital model of care included increased health care resource efficiency, clinician familiarity with telehealth, as well as a perceived reduction in overmedicalization and infection risk.

CONCLUSIONS

The successful implementation of Back@Home relies on key stakeholder buy-in. Addressing barriers to implementation and building on enablers is crucial to clinicians' adoption of this model of care. Based on clinicians' input, the Back@Home model of care will incorporate the loan of internet-enabled devices, health care interpreters, and written resources translated into community languages to facilitate more equitable access to care for marginalized groups.

Evaluating Web-Based Care for Mental Health and Substance Use Issues for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, and 2-Spirit Youths in the Context of the COVID-19 Pandemic: Community-Based Participatory Research Study

BACKGROUND

Mental health (MH) and substance use (SU) care supports are often difficult to access for the lesbian, gay, bisexual, transgender, queer, questioning, and 2-spirit (LGBTQ2S+) population. There is little known on how the shift to web-based care has affected and changed the experiences of LGBTQ2S+ youths within the MH care system.

OBJECTIVE

This study sought to examine how web-based care modalities have affected access to care and quality of care for LGBTQ2S+ youths seeking MH and SU services.

METHODS

Researchers used a web-based co-design method to explore this population's relationship with MH and SU care supports, focusing on the experiences of 33 LGBTQ2S+ youths and their relationship with MH and SU supports during the COVID-19 pandemic. A participatory design research method was used to gain experiential knowledge of LGBTQ2S+ youths' lived experience with accessing MH and SU care. Thematic analysis was used to examine the resulting audio-recorded data transcripts and create themes.

RESULTS

Themes related to web-based care included accessibility, web-based communication, provision of choice, and provider relationship and interactions. Barriers to care were identified in particular for disabled youths, rural youths, and other participants with marginalized intersecting identities. Unexpected benefits of web-based care were also found and emphasize the idea that this modality is beneficial for some LGBTQ2S+ youths.

CONCLUSIONS

During the COVID-19 pandemic, a time where MH- and SU-related problems have increased, programs need to reevaluate current measures so that the negative effects of web-based care modalities can be reduced for this population. Implications for practice encourage service providers to be more empathetic and transparent when providing services for LGBTQ2S+ youths. It is suggested that LGBTQ2S+ care should be provided by LGBTQ2S+ folks or organizations or service providers who are trained by LGBTQ2S+ community members. Additionally, hybrid models of care should be established in the future so that LGBTQ2S+ youths have the option to access in-person services, web-based ones, or both as there can be benefits to web-based care once it has been properly developed. Implications for policy also include moving away from a traditional health care team model and developing free and lower-cost services in remote areas.

Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study

BACKGROUND

Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital technologies offer promise, yet challenges in real-world integration and uptake persist. Moderated Online Social Therapy (MOST) aims to overcome these problems by integrating a comprehensive digital platform into existing youth mental health services. Theory of change (ToC) frameworks can help articulate how and why complex interventions work and what conditions are required for success.

OBJECTIVE

The objective of this study is to create a ToC for MOST to explain how it works, why it works, who benefits and how, and what conditions are required for its success.

METHODS

We used a multimethod approach to construct a ToC for MOST. The synthesis aimed to assess the real-world impact of MOST, a digital platform designed to enhance face-to-face youth mental health services, and to guide its iterative refinement. Data were gathered from 2 completed and 4 ongoing randomized controlled trials, 11 pilot studies, and over 1000 co-design sessions using MOST. Additionally, published qualitative findings from diverse clinical contexts and a review of related digital mental health literature were included. The study culminated in an updated ToC framework informed by expert feedback. The final ToC was produced in both narrative and table form and captured components common in program logic and ToC frameworks.

RESULTS

The MOST ToC captured several assumptions about digital mental health adoption, including factors such as the readiness of young people and service providers to embrace digital platforms. External considerations included high service demand and a potential lack of infrastructure to support integration. Young people and service providers face several challenges and pain points MOST seeks to address, such as limited accessibility, high demand, poor engagement, and a lack of personalized support. Self-determination theory, transdiagnostic psychological treatment approaches, and evidence-based implementation theories and their associated mechanisms are drawn upon to frame the intervention components that make up the platform. Platform usage data are captured and linked to short-, medium-, and long-term intended outcomes, such as reductions in mental health symptoms, improvements in functioning and quality of life, reductions in hospital visits, and reduced overall mental health care costs.

CONCLUSIONS

The MOST ToC serves as a strategic framework for refining MOST over time. The creation of the ToC helped guide the development of therapeutic content personalization, user engagement enhancement, and clinician adoption through specialized implementation frameworks. While powerful, the ToC approach has its limitations, such as a lack of standardized methodology and the amount of resourcing required for its development. Nonetheless, it provides an invaluable roadmap for iterative development, evaluation, and scaling of MOST and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact.

Developing Health Management Competency for Digital Health Transformation: Protocol for a Qualitative Study

BACKGROUND

Globally, the health care system is experiencing a period of rapid and radical change. In response, innovative service models have been adopted for the delivery of high-quality care that require a health workforce with skills to support transformation and new ways of working.

OBJECTIVE

The aim of this research protocol is to describe research that will contribute to developing the capability of health service managers in the digital health era and enabling digital transformation within the Australian health care environment. It also explains the process of preparing and finalizing the research design and methodologies by seeking answers to the following three research questions: (1) To what extent can the existing health service management and digital health competency frameworks guide the development of competence for health service managers in understanding and managing in the digital health space? (2) What are the competencies that are necessary for health service managers to acquire in order to effectively work with and manage in the digital health context? (3) What are the key factors that enable and inhibit health service managers to develop and demonstrate digital health competence in the workplace?

METHODS

The study has adopted a qualitative approach, guided by the empirically validated management competency identification process, using four steps: (1) health management and digital health competency mapping, (2) scoping review of literature and policy analysis, (3) focus group discussions with health service managers, and (4) semistructured interviews with digital health leaders. The first 2 steps were to confirm the need for updating the current health service management curriculum to address changing competency requirements of health service managers in the digital health context.

RESULTS

Two initial steps have been completed confirming the significance of the study and study design. Step 1, competency mapping, found that nearly half of the digital competencies were only partially or not addressed at all by the health management competency framework. The scoping review articulated the competencies health service managers need to effectively demonstrate digital health competence in the workplace. The findings effectively support the importance of the current research and also the appropriateness of the proposed steps 3 and 4 in answering the research questions and achieving the research aim.

CONCLUSIONS

This study will provide insights into the health service management workforce performance and development needs for digital health and inform credentialing and professional development requirements. This will guide health service managers in leading and managing the adoption and implementation of digital health as a contemporary tool for health care delivery. The study will develop an in-depth understanding of Australian health service managers' experiences and views. This research process could be applied in other contexts, noting that the results need contextualization to individual country jurisdictions and environments.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51884.

Patient Satisfaction With Dental Services

Patient satisfaction is an integral aspect of healthcare quality assessment, and it plays a crucial role in evaluating the effectiveness of healthcare services. This systematic review investigates patient satisfaction with dental services provided by public dental hospitals in rural and remote areas of Saudi Arabia. The study conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards. It involved a comprehensive search across multiple databases, including Medline, Cochrane, Embase, and CINAHL, with tailored search strategies for each database using MeSH terms and keywords. To ensure inclusivity, the search covered publications in both English and Arabic and included Google Scholar for gray literature. Inclusion criteria focused on empirical studies conducted in rural and remote public hospitals in Saudi Arabia, published between 2013 and January 2023, assessing patient satisfaction in oral or dental care for adult patients. Data screening and extraction followed a rigorous two-step process, and a narrative synthesis was used to analyze and summarize the findings. The findings reveal a complex landscape of patient satisfaction in these settings, with varying levels of contentment reported. While more than 50% of patients expressed satisfaction with the quality of dental care, significant challenges related to accessibility were evident. Patients residing in remote and rural areas often had to travel long distances to access dental clinics, resulting in dissatisfaction. Demographic factors, particularly education and age, were identified as significant influencers of patient satisfaction, with more educated individuals tending to be less satisfied. This study emphasizes the importance of continuous monitoring of patient satisfaction to enhance service delivery, particularly in public dental clinics serving remote and rural areas. Addressing issues related to access, availability, clinical quality, and effective communication is vital for improving patient satisfaction in these healthcare settings. The study concludes with recommendations for policymakers, including the development of quality assurance policies, cost mitigation strategies, and targeted interventions to address demographic disparities and enhance patient satisfaction with dental care services.

Accessing care during the pandemic: A UK wide survey of people with rheumatoid arthritis and adult juvenile inflammatory arthritis during the COVID-19 pandemic

COVID-19 drastically changed healthcare delivery models for rheumatology services. We sought to understand the impact of these changes for patients with Rheumatoid Arthritis (RA) and adult Juvenile Inflammatory Arthritis (AJIA) in established patients and those newly diagnosed during the pandemic. RESULTS: Of the 316 participants, a significant proportion regularly used analgesics (45.4%, n = 119), corticosteroids (17.9%, n = 47) and Non-Steroidal Anti-Inflammatory Drugs [(NSAIDs) (36.6%, n = 96)]. Two thirds of participants (66.5%, n = 210) did not know their Disease Activity Score-28 (DAS28). Of the remaining third, moderate disease activity (12%, n = 38) was most reported. We found that 16.8% (n = 53) felt their condition was managed well during the pandemic. The remainder felt more negatively. For the newly diagnosed cohort, 34.5% (n = 10) delayed seeking GP help because of COVID-19 concerns. Once assessed, a quarter (24.1%, n = 7) were referred to rheumatology after 4 or more consultations. We found 47% (n = 77) expressed positive opinions on remote consultations, whereas 36% (n = 59) had concerns. The lack of clinical examination (42.5%, n = 25) was flagged. Changing the dynamic from health worker to a patient centred approach was the most wished for improvement (20.3%, n = 64). CONCLUSIONS: Most participants did not know their disease activity status, which is of concern. With a push towards patient-centred and patient-led care, education and supported self-management is critically important. There is high use of NSAIDs and corticosteroids. Pathways of care underwent change with subsequent delays in specialist assessment. The introduction of patient-initiated follow-up (PIFU) and virtual consultations further distances healthcare professionals from patients and could affect outcomes.

'Auspicious liaisons'-evaluating the impact of a liaison geriatrician initiative on older adults psychiatric wards

BACKGROUND

Although liaison services in acute hospitals are now the norm, the reverse is not usually available for patients in mental health trusts. Following the introduction of support from geriatricians to older people's mental health inpatient wards, we wanted to see if this intervention was effective and acceptable to clinicians.

METHODS

We performed a retrospective cohort service evaluation on the impact of a liaison geriatrician, using routinely collected data, and assessed acceptability among medical staff by semi-structured interview.

INTERVENTION

Our service introduced regular sessions from consultant community geriatricians across older adults psychiatric wards including a mixture of video conference and face-to-face input.

RESULTS

There was no significant decrease in emergency transfers but there was a significant reduction in length of stay with an associated cost benefit for the service after the introduction of a liaison geriatrician. There was a significant increase in geriatrician consultations and a decrease in specialty consultations to other specialists. There was no change in discharge prescriptions or destination. There was a significant reduction in falls in the intervention arm but not in falls leading to emergency hospital admissions geriatricians gave confidence to psychiatrists of all grades to treat physical health care issues.

CONCLUSIONS

A liaison geriatrician service may be a component in reducing length of stay (although there are many others) and improving continuity of care, although it confers no impact on emergency transfers. The intervention was highly acceptable to clinicians.

A Quality-of-Service-Aware Service Composition Method in the Internet of Things Using a Multi-Objective Fuzzy-Based Hybrid Algorithm

The Internet of Things (IoT) represents a cutting-edge technical domain, encompassing billions of intelligent objects capable of bridging the physical and virtual worlds across various locations. IoT services are responsible for delivering essential functionalities. In this dynamic and interconnected IoT landscape, providing high-quality services is paramount to enhancing user experiences and optimizing system efficiency. Service composition techniques come into play to address user requests in IoT applications, allowing various IoT services to collaborate seamlessly. Considering the resource limitations of IoT devices, they often leverage cloud infrastructures to overcome technological constraints, benefiting from unlimited resources and capabilities. Moreover, the emergence of fog computing has gained prominence, facilitating IoT application processing in edge networks closer to IoT sensors and effectively reducing delays inherent in cloud data centers. In this context, our study proposes a cloud-/fog-based service composition for IoT, introducing a novel fuzzy-based hybrid algorithm. This algorithm ingeniously combines Ant Colony Optimization (ACO) and Artificial Bee Colony (ABC) optimization algorithms, taking into account energy consumption and Quality of Service (QoS) factors during the service selection process. By leveraging this fuzzy-based hybrid algorithm, our approach aims to revolutionize service composition in IoT environments by empowering intelligent decision-making capabilities and ensuring optimal user satisfaction. Our experimental results demonstrate the effectiveness of the proposed strategy in successfully fulfilling service composition requests by identifying suitable services. When compared to recently introduced methods, our hybrid approach yields significant benefits. On average, it reduces energy consumption by 17.11%, enhances availability and reliability by 8.27% and 4.52%, respectively, and improves the average cost by 21.56%.

Performance measures for alcohol and other drugs services: a commentary

Alcohol and other drugs treatment includes a wide range of service and personal characteristics, along with expected and unexpected barriers to treatment. To capture the benefits and the gaps of a designed treatment, one needs to consider process-of-care and outcome measurements. Process-of-care measures are mainly developments of the rationale proposed by The Washington Circle and capture all variants in the process-of-care as proportions. Outcome measures are strongly related to different concepts of recovery and described as simple yes/no answers type to wide levels of response, such as in Likert-type scales. According to the studies collected here, more realistic periods of data-collection for process-of-care measures and a more reliable format to capture outcome particularities should be designed.

Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care

Variations in the rates of involuntary admission (IA) reflect the influence of unexplained contextual variables that are typically too heterogeneous to be included in systematic reviews. This paper attempts to gather and analyze factors unrelated to the patients that have been linked to IA. The articles included in this review were selected by iteratively searching four electronic databases (PubMed, PsychINFO, EMBASE, and Web of Science). A total of 54 studies from 19 different countries and regions, including 14 European countries, the United States, Canada, China, Vietnam, and Taiwan, were selected. The factors were categorized as service-related factors, impactful events, seasonal and temporal factors, mental health legislation, staff factors, and public attitudes. The factors rarely act in isolation but rather interact and reinforce each other, causing a greater influence on IA. This paper explains how these factors present opportunities for robust and sustainable interventions to reduce IAs. The paper also identifies future directions for research, such as examining the effects of economic recessions. Enhancing global reporting standards is essential to validate future research and support further in-depth studies. The complexity of the factors influencing IA and the implicit role of society suggest that resolving it will require social change.

Forest Ecosystem Service Trade-Offs/Synergies and System Function Optimization in Karst Desertification Control

Karst desertification control forests are essential for ecosystem multi functionality, but the trade-offs/synergies are unclear for forest ecosystem services. In order to clarify the trade-offs/synergies, this study was conducted on eight forest communities in a karst desertification control area and was based on vegetation surveys and structural and functional monitoring. It analyzes water holding capacity, species diversity, soil conservation, and carbon storage characteristics and their trade-off/synergies. The results indicate the following: (1) The Cladrastis platycarpa + Cotinus coggygria community (H1) had the highest water holding capacity and species diversity with values of 252.21 t·hm^-2 and 2.56, respectively. Soil conservation was highest in the Zanthoxylum bungeanum + Glycine max community (H6), with an index value of 1.56. Carbon storage was the greatest in the Tectona grandis community (H8), at 103.93 t·hm^-2. The results of these studies have shown that there are significant differences in different types of forest community ecosystem services. (2) Water holding capacity, species diversity, soil conservation, and carbon storage, all have synergistic relationships, suggesting a trend towards synergistic enhancement between the services. (3) The species diversity of the forest ecosystems was shown to be in a trade-off with carbon storage and soil conservation, which suggests that the services are in competition with each other. To further improve the service capacity of forest ecosystems, the trade-offs between the regulation of forest community structure and function and the improvement of services should be optimized.

Formal Analysis of Trust and Reputation for Service Composition in IoT

The exponential growth in the number of smart devices connected to the Internet of Things (IoT) that are associated with various IoT-based smart applications and services, raises interoperability challenges. Service-oriented architecture for IoT (SOA-IoT) solutions has been introduced to deal with these interoperability challenges by integrating web services into sensor networks via IoT-optimized gateways to fill the gap between devices, networks, and access terminals. The main aim of service composition is to transform user requirements into a composite service execution. Different methods have been used to perform service composition, which has been classified as trust-based and non-trust-based. The existing studies in this field have reported that trust-based approaches outperform non-trust-based ones. Trust-based service composition approaches use the trust and reputation system as a brain to select appropriate service providers (SPs) for the service composition plan. The trust and reputation system computes each candidate SP's trust value and selects the SP with the highest trust value for the service composition plan. The trust system computes the trust value from the self-observation of the service requestor (SR) and other service consumers' (SCs) recommendations. Several experimental solutions have been proposed to deal with trust-based service composition in the IoT; however, a formal method for trust-based service composition in the IoT is lacking. In this study, we used the formal method for representing the components of trust-based service management in the IoT, by using higher-order logic (HOL) and verifying the different behaviors in the trust system and the trust value computation processes. Our findings showed that the presence of malicious nodes performing trust attacks leads to biased trust value computation, which results in inappropriate SP selection during the service composition. The formal analysis has given us a clear insight and complete understanding, which will assist in the development of a robust trust system.

'Thinking about myself?' Experiences of parents of adolescents with cerebral palsy: A qualitative study to guide the implementation of a service for families

BACKGROUND

Recently, there has been an increase in the development of transition services for adolescents with cerebral palsy (CP). Studies have emphasized the importance of addressing parents' needs during their children's adolescence.

AIMS

This study aimed to understand how parents experience the adolescence and transition to adulthood of their adolescents with CP and to identify relevant components for the development of a service for families.

METHODS AND PROCEDURES

A qualitative study was conducted with 18 families of adolescents with CP. Caregivers were purposely recruited from a transition programme called Adolescence in Focus Program. Individual interviews were conducted using a semistructured script. Then, the caregivers were invited to participate in focus groups. The interviews and focus groups were recorded and transcribed for content analysis.

RESULTS

Three categories emerged: 'The onset of adolescence', 'What will our future be?' and 'Support and services: paths to follow'. The adolescents' behavioural changes seemed to be intensified by their restricted social participation. Parents reported the desire for their adolescents to become independent in daily activities. Regarding their own future, they aimed to re-establish the occupational roles that were interrupted.

CONCLUSION

Information from this study guided the design of a programme for families regarding content, format and outcomes.

Impact of a Public Health Awareness Campaign on Patients' Perceptions of Expanded Pharmacy Services in South Dakota Using the Theory of Planned Behavior

Background: Pharmacists can offer medication expertise to help better control diabetes and cardiovascular disease (CVD) and improve patient outcomes, particularly in rural communities. This project evaluated the impact of an awareness campaign on perceptions of expanded pharmacy services. Methods: The “Your Pharmacists Knows” campaign included a 30-s commercial, print material, and media announcements. A non-randomized pre-post study was completed using a modified theory of planned behavior (mTPB) to assess knowledge, attitude, perceived benefits and norms, and perceived control. A 73-item survey was administered to a convenience sample (n = 172) across South Dakota. Regression models to assess intent and utilization were conducted using age, gender, race, education, population, and insurance status as predictors for mTPB constructs. Results: Most common predictors were female gender and higher education level (p < 0.001). All mTPB constructs were significant predictors of intent to use services (p < 0.001). Knowledge and perceived control had the largest influence on intent. Additionally, there was significant improvement in post-campaign service utilization (p < 0.001). Conclusions: This campaign positively influenced intent to seek and utilize services in rural communities where pharmacies may be the only healthcare option for miles. Through targeted campaigns, patients with diabetes or CVD may find access to services to better manage their conditions.

Exposure to ionizing radiation by service personnel working with cyclotrons used to produce radiopharmaceuticals in PET diagnostics

OBJECTIVES

While working with cyclotrons used for the production of radiopharmaceuticals, workers can experience significant exposure to the adverse effects of ionizing radiation. The aim of this paper was to determine the typical level of such exposure received by such personnel while servicing cyclotrons.

MATERIAL AND METHODS

Exposure was assessed using TLD detectors placed in an anthropomorphic phantom, as well as dose meter to determine whole body and eye lens exposure. The phantom was placed in locations receiving the greatest exposure to ionizing radiation during service activities. The time spent by employees during servicing was assessed based on routine visits by service technicians. The obtained results were compared with readings of detectors worn by employees during service activities.

RESULTS

The highest equivalent doses in the thoracic area were found to be received by the lungs (211.16 μSv/year). In the head and neck area, the highest dose was measured in the eye lens (3410 μSv/year). The effective dose for the whole body was found to be 1154.4 μSv/year, based on the phantom, and 149 μSv per service visit (1192 μSv/year), based on the dose meters carried by the workers.

CONCLUSIONS

Service workers are exposed to significant doses of ionizing radiation, representing a clear radiological protection issue. To reduce exposure to eye lenses, it is recommended to use protective goggles when working with highly-radioactive elements. Int J Occup Med Environ Health. 2022;35(6):753-60.

Desires and Attitudes towards Telepharmacy Medicine Delivery

The COVID-19 pandemic has limited healthcare services for patients with non-communicable diseases (NCDs). Hospital pharmacy departments in Thailand apply a new normal pharmacy service known as "telepharmacy" to serve remote pharmacy practice and deliver medication to patients. Current knowledge clearly shows the benefit of each medicine delivery method, but the study of patient's desires and attitudes towards all drug delivery methods is still limited. To fill the gap, this study aims to investigate desires and attitudes about drug delivery methods among Thai patients living with NCDs who need regular and continuous care. The sample was included by accidentally randomized technique at NCD clinics of the southern Thailand tertiary care hospital. Data were collected between January and March 2021 by a questionnaire that contained three sections: the currently received medicine delivery method, the desires and attitudes about the medicine delivery system, and patients' demographic information. The majority of patients were women aged 60 years who earned less than 10,000 THB (263.85 USD), were enrolled in the Civil Servant Medical Benefit Scheme (CSMBS), lived 0-15 km from the hospital, living with hypertension, had 1-4 prescribed medications, visited the doctor every 3 months, and received the conventional drug delivery method. The result showed that only the subdistrict health promotion hospital (SHPH) medicine delivery method was at a high level of desire, while the rest including conventional, drug store, postal pharmacy, and drive-thru medicine delivery methods were at medium. Attitudes toward the quality of medicine delivery methods consisted of five dimensions: confidence, timeliness, reliability, empathy, and facilities. Thai NCD patients had positive attitudes toward SHPH and drug store medicine delivery methods that could be seen from the high level of attitude score across all dimensions, while postal pharmacy and drive-thru delivery methods received medium-level attitude scores across all five dimensions.

"Listen to us!" A qualitative study of adolescents with disabilities to help plan a transition service

BACKGROUND

The development and implementation of transition services for adolescents with disabilities should incorporate perceptions of their needs and interests. The aim of the study was to understand the concerns of adolescents with physical disabilities during adolescence and their expectations regarding adulthood to help plan a transition programme in Brazil.

METHODS

This is a qualitative study, using a phenomenological approach. Eight adolescents with physical disabilities (seven with cerebral palsy, one with muscular dystrophy), aged between 15 and 17 years, participated in two focus groups. Prior to the conduction of the groups, clinicians selected topics related to adolescence and the transition to adulthood, based on their professional experience and available literature. During the focus groups, illustrative images of each topic were presented to the participants. Each adolescent was asked to select five topics that he/she considered important to be discussed in a future transition programme. The participants justified their individual choices and, in groups, reached a consensus on the groups' priorities. This strategy was chosen to motivate the discussion among the participants and to explore their concerns regarding adolescence and transition to adulthood. The focus groups were audio recorded and transcribed for content analysis.

RESULTS

Three themes emerged from the content analysis: (1) "Adolescents and their social relationships," (2) "Identity formation: self-awareness and development of autonomy," and (3) "What about adulthood?"

CONCLUSION

The themes revealed conflicts between the adolescents' desire to achieve independence and autonomy and the awareness of their limitations. The interpretation of the results helped structuring the actions of the Adolescence in Focus Programme, with two main actions: promotion of the adolescent's functional performance in daily living activities and assistance with their identity formation and preparation for adulthood.

Piloting a Community Education Skin Cancer Program Coordinated by Medical Students

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How COVID-19 has impacted immunisation service delivery in Australia: a national study

OBJECTIVE

The objective of this study was to determine the impact the COVID-19 pandemic had on the delivery of adult, maternal and childhood immunisation services in Australia in 2020 prior to the rollout of COVID-19 vaccines, and to understand the adaptations made at a service delivery level that may have contributed to the successful delivery of immunisation services during the first year of the pandemic.

METHODS

An electronic survey was sent to immunisation providers and pharmacists in all states and territories in Australia between November 2020 and December 2020. It explored interruption to the delivery of immunisation services, strategies implemented to maintain services, prioritisation of populations, and self-reported challenges and solutions initiated by providers.

RESULTS

A total of 850 people responded to the survey. Of these, the most common professional groups identified were pharmacists followed by nurse immunisers, nurses/midwives and general practitioners. Several changes were implemented including relocation of vaccination clinics, change to bookings rather than walk-in appointments, infection prevention measures, clients waiting in cars pre- and post-vaccination and reduced observation period post-vaccination.

CONCLUSION

The pandemic has provided opportunities for services to trial new and innovative strategies such as electronic pre-assessment, electronic consent and drive-through vaccination services.

IMPLICATIONS FOR PUBLIC HEALTH

Immunisation providers mostly viewed these changes positively and intend to continue many post-pandemic. The experience gained from the trialling of these strategies may be adapted for vaccine delivery and National Immunisation Program vaccines beyond the pandemic.

Fragility fracture management and FLS models in South Africa and Israel

Osteoporosis is a common disease of the elderly. Many patients at high risk are neither identified nor treated. A Fracture Liaison Service is a coordinated model of care for secondary fracture prevention. Several national quality indicators have been published in each country to improve surgical treatment and osteoporosis medical treatment. Fracture Liaison Services in both countries have been created by local clinicians with different models depending on the medical geographic locations of patients and the local setup. The objective of this review is to describe the national guidelines and the current clinical treatment models for fragility fractures in South Africa and Israel. Successes and barriers to successful implementation have been identified and are summarized.

Beneficial Effects of Motor Imagery and Self-Talk on Service Performance in Skilled Tennis Players

This research aim to investigate the effects of motor imagery (MI), focused on the trajectory of the ball and the target area, and self-talk (motivational function) before the actual strike on the performance of the service in skilled tennis players. Thirty-three participants (6 females and 27 males, M_age = 15.9 years), competing in regional to national competitions, were randomly divided into three groups: Control, MI, and MI + self-talk. They performed a pre-test (25 first service), 20 acquisition sessions (physical trial, physical trial + MI and physical trial + MI + self-talk), and a post-test similar to the pre-test, in match situations. The percentage of the first service, their speed, and the efficiency scores, evaluated by experts, were use as dependent variables and indicators of performance. While there was no difference in service speed ( p > 0.05), this study showed an improvement in the first service percentage and efficiency (all ps < 0.01) in the participants of the MI and MI + self-talk groups. Additionally, analyses revealed greater efficiency when MI was combined with self-talk compared to other conditions. It, therefore, seems advantageous for skilled tennis players to use MI and motivational self-talk before performing the first service balls.

The Impact of Different Factors on Repeat Visits to Selected International Tourism Enterprises: Case Study From Czechia

The aim of this article is to identify the influence of the different factors on the repeat visits to selected international tourism enterprises based on the responses of customers in Czechia. The selected factors were divided into three main groups: service, environment, and offer, and each of these groups consists of other different factors. Primary data were analyzed using SPSS software. Statistical hypotheses were formed, reflecting the relationship between the difference in customer responses and selected quality factors, which can affect repeated visits to selected tourism enterprises. Most customers of repeat visits to selected tourism enterprises are affected by professional behavior, staff empathetic approach, offer knowledge and ability to provide as much information as possible, cleanliness and tidiness, overall atmosphere of the establishment, lighting and thermal comfort, air cleanliness, and plenty of space, taste and quality of food and ingredients, and last but not least also corresponding ratio of price/quality, good experience and attractive price level. Studying consumer behavior is important because it helps marketers understand what influences consumers' buying decisions not only in the tourism area in the Czechia but can fill in the market gap and identify the new products and services that are needed.

Factors influencing utilization of early postnatal care services among postpartum women in Yirgalem town, Sidama Regional State, Ethiopia

Objective:

Providing postnatal care services at right time could help to reduce maternal and newborn deaths. Thus, this study aimed to assess the factors influencing the utilization of early postnatal care services among postpartum women in Yirgalem town, Sidama Regional State, Ethiopia.

Methods:

A community-based cross-sectional study was done using structured and interviewer-administered questionnaires among randomly selected 306 postpartum women. Data were cleaned, coded, and entered into EpiData-3.1, and exported to Statistical Package for Social Science-21 for analysis. Descriptive statistics, bivariable, and multivariable logistic regression analysis were done. A p-value ⩽ 0.05 was used to consider statistically significant variables.

Results:

Generally, 202 (66.7%) visited a health facility for postpartum care. The prevalence of early postnatal care service utilization was 45.5% (95% confidence interval = 39.9–50.5). Mainly practiced services were physical examination (37%) and family planning (31%) services. Having formal education (adjusted odds ratio = 3.6; 95% confidence interval = 1.7–7.4), having antenatal care (adjusted odds ratio = 3.5; 95% confidence interval = 1.6–7.6), institutional delivery (adjusted odds ratio = 2.3; 95% confidence interval = 1.2–4.7), and getting advice from healthcare provider (adjusted odds ratio = 18.69; 95% confidence interval = 9.19–37.99) were factors significantly associated with early postnatal care service utilization.

Conclusion:

The practice of early postnatal care needs more attention in the study area. Improving the educational status of the women, strengthening healthcare providers’ counseling on the benefits of postnatal care, and inspiring pregnant women to use antenatal care and institutional delivery services will improve the use of postnatal care services on time.

In Search for Comparability: The PECUNIA Reference Unit Costs for Health and Social Care Services in Europe

Improving the efficiency of mental healthcare service delivery by learning from international best-practice examples requires valid data, including robust unit costs, which currently often lack cross-country comparability. The European ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA) aimed to harmonize the international unit cost development. This article presents the methodology and set of 36 externally validated, standardized reference unit costs (RUCs) for five health and social care services (general practitioner, dentist, help-line, day-care center, nursing home) in Austria, England, Germany, Hungary, The Netherlands, and Spain based on unambiguous service definitions using the extended DESDE PECUNIA coding framework. The resulting PECUNIA RUCs are largely comparable across countries, with any causes for deviations (e.g., country-specific scope of services) transparently documented. Even under standardized methods, notable limitations due to data-driven divergences in key costing parameters remain. Increased cross-country comparability by adopting a uniform methodology and definitions can advance the quality of evidence-based policy guidance derived from health economic evaluations. The PECUNIA RUCs are available free of charge and aim to significantly improve the quality and feasibility of future economic evaluations and their transferability across mental health systems.

Social Determinants of Health Screening by Preclinical Medical Students During the COVID-19 Pandemic: Service-Based Learning Case Study

BACKGROUND

The inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how to prepare preclinical students for real-world screening and referrals for addressing social determinants of health.

OBJECTIVE

This pilot project's objective was to evaluate the feasibility of using a real-world, service-based learning approach for training preclinical students to assess social needs and make relevant referrals via the electronic medical record during the COVID-19 pandemic (May to June 2020).

METHODS

This project was designed to address an acute community service need and to teach preclinical, second-year medical student volunteers (n=11) how to assess social needs and make referrals by using the 10-item Social Determinants of Health Screening Questionnaire in the electronic health record (EHR; Epic platform; Epic Systems Corporation). Third-year medical student volunteers (n=3), who had completed 6 clinical rotations, led the 2-hour skills development orientation and were available for ongoing mentoring and peer support. All student-patient communication was conducted by telephone, and bilingual (English and Spanish) students called the patients who preferred to communicate in Spanish. We analyzed EHR data extracted from Epic to evaluate screening and data extracted from REDCap (Research Electronic Data Capture; Vanderbilt University) to evaluate community health workers' notes. We elicited feedback from the participating preclinical students to evaluate the future use of this community-based service learning approach in our preclinical curriculum.

RESULTS

The preclinical students completed 45 screening interviews. Of the 45 screened patients, 20 (44%) screened positive for at least 1 social need. Almost all of these patients (19/20, 95%) were referred to the community health worker. Half (8/16, 50%) of the patients who had consultations with the community health worker were connected with a relevant social service resource. The preclinical students indicated that project participation increased their ability to assess social needs and make needed EHR referrals. Food insecurity was the most common social need.

CONCLUSIONS

Practical exposure to social needs assessment has the potential to help preclinical medical students develop the ability to address social concerns prior to entering clinical clerkships in their third year of medical school. The students can also become familiar with the EHR prior to entering third-year clerkships. Physicians, who are aware of social needs and have the electronic medical record tools and staff resources needed to act, can create workflows to make social needs assessments and services integral components of health care. Research studies and quality improvement initiatives need to investigate how to integrate screening for social needs and connecting patients to the appropriate social services into routine primary care procedures.

Understanding the Experience of Service Users in an Integrated Care Programme for Obesity and Mental Health: A Qualitative Investigation of Total Wellbeing Luton

Obesity is a complex public health issue with multiple contributing factors. The emphasis on joined care has led to the development and implementation of a number of integrated care interventions targeting obesity and mental health. The purpose of this study was to examine user experience in an integrated care programme for obesity and mental health in Luton, UK. Semi-structured interviews were conducted with a purposeful sample of service users (N = 14). Interview transcripts were analysed using thematic analysis. Analysis of the interviews identified six main themes for understanding service users' experiences of integrated care: (1) 'A user-centered system', (2) 'Supports behaviour change', (3) 'Valued social support', (4) 'Communication is key', (5) 'Flexible referral process', and (6) 'Positive impact on life'. These themes describe how the service is operated, evidence perceived value service users place on social support in behavior change intervention, and address which service areas work well and which require improvement. The findings of these interviews have offered a significant contribution to understanding what service users value the most in an integrated healthcare setting. Service users value ongoing support and being listened to by healthcare professionals, as well as the camaraderie and knowledge acquisition to support their own behaviour change and promote self-regulation following their participation in the programme.

In Service to Others: A New Evolutionary Perspective on Human Enhancement

In enhancement ethics, evolutionary theory has been largely perceived as supporting liberal views on enhancement, in which decisions to enhance are predominantly regulated by the principle of individual autonomy. In this article, I critique this perception in light of recent scientific developments. Cultural evolutionary theory suggests a picture in which individual interests are entangled with community interests, and this undermines the applicability of the principle of autonomy. This is particularly relevant for enhancement ethics given how-I argue-decisions to enhance are often influenced by desires to increase social status. The service view on enhancement, based on principles of service and trust, offers, I propose, better guidance for the challenges of social living.

Public health nurse education in the Nordic countries

BACKGROUND

Higher education should promote critical reflection and guide students towards international activities. In the Nordic countries public health nurse educational programmes are mostly based on guidelines issued by national educational authorities, which describe students' learning outcomes.

AIM

The aim of this paper is twofold: to give an overview of public health nurse education and service in the Nordic countries and thereby discuss opportunities for collaboration within the programmes.

DATA SOURCES AND COMPILATION OF DATA

National legislations for public health nurse education and services are used as data. Since all sources are written in the language of each country, all the authors wrote the parts that describe each countries conditions in English and contributed to the compilation of data.

RESULTS

We found both similarities and differences in public health nurse education and services. Opportunities for collaboration between the programmes are discussed.

CONCLUSION

Critical reflection by the public health nurse students can be enhanced by arranging collaboration projects, an exchange of clinical placement, and joint master projects. Collaboration among academic staff within the educational programmes, in education and research, have the potential to enhance quality both within public health nurse education and in developing the profession of public health nursing.

Maternal Satisfaction With Delivery Services and its Associated Factors Among Mothers Who Gave Birth at Public Health Centers in Yeka Sub City, Addis Ababa, Ethiopia

This study aimed to assess maternal satisfaction and associated factors with delivery care services uptake among mothers who gave birth at public health centers. An institution-based cross-sectional study was conducted in the Yeka Sub-City in Addis Ababa, Ethiopia. A systematic sampling technique was used to select mothers. Bivariable and multivariable analysis was done to identify associated variables. The overall mothers’ satisfaction with delivery care services uptake was 63%. The median age of the participants was 28 years. In multivariable analysis privacy measures taken at delivery care services uptake, mothers’ education level, occupational status of mothers, and family income level of mothers were associated with mothers’ satisfaction in delivery care services. Mother’s income levels of 1501 to 5000 birr were satisfied with the service (AOR = 2.49; 95% CI: 1.3, 4.76). However, mothers whose income below1500 birr were dissatisfied. In conclusion, a mother’s educational level, occupational status, and family income affect mothers’ satisfaction with delivery care services uptake in public health centers, in the Yeka Sub-City. Evaluating health care services uptake from the client’s point of view and targeting to identify problems is very necessary.

Nanowelding in Whole-Lifetime Bottom-Up Manufacturing: From Assembly to Service

The continuous miniaturization of microelectronics is pushing the transformation of nanomanufacturing modes from top-down to bottom-up. Bottom-up manufacturing is essentially the way of assembling nanostructures from atoms, clusters, quantum dots, etc. The assembly process relies on nanowelding which also existed in the synthesis process of nanostructures, construction and repair of nanonetworks, interconnects, integrated circuits, and nanodevices. First, many kinds of novel nanomaterials and nanostructures from 0D to 1D, and even 2D are synthesized by nanowelding. Second, the connection of nanostructures and interfaces between metal/semiconductor-metal/semiconductor is realized through low-temperature heat-assisted nanowelding, mechanical-assisted nanowelding, or cold welding. Finally, 2D and 3D interconnects, flexible transparent electrodes, integrated circuits, and nanodevices are constructed, functioned, or self-healed by nanowelding. All of the three nanomanufacturing stages follow the rule of "oriented attachment" mechanisms. Thus, the whole-lifetime bottom-up manufacturing process from the synthesis and connection of nanostructures to the construction and service of nanodevices can be organically integrated by nanowelding. The authors hope this review can bring some new perspective in future semiconductor industrialization development in the expansion of multi-material systems, technology pathway for the refined design, controlled synthesis and in situ characterization of complex nanostructures, and the strategies to develop and repair novel nanodevices in service.

Evaluation of an inner city HIV pre-exposure prophylaxis service tailored to the needs of people who inject drugs

OBJECTIVES

HIV prevention strategies including pre-exposure prophylaxis (PrEP) must reach all in need to achieve elimination of transmission by 2030. Mainstream provision may inadvertently exclude key populations. Incidence of HIV in people who inject drugs (PWID) in Glasgow, Scotland's largest city, is increasing, partly due to sexual transmission. Scotland provides publicly funded oral PrEP for individuals at sexual risk of HIV through sexual health services; however, uptake by PWID has been negligible. We developed a tailored outreach PrEP service based in the local homeless health centre. We used active case finding, flexibility of assessment location, supervised community daily dispensing and active follow-up to optimise uptake and adherence. We describe a two-year service evaluation.

METHODS

We reviewed the case records of all PWID identified by the outreach team as being at higher risk of sexual acquisition for whom PrEP was considered between November 2018 and November 2020. Evaluation focused on PrEP uptake, adherence and monitoring. We conducted a descriptive statistical analysis.

RESULTS

Of 41 PWID assessed as eligible, 32 (78.0%) commenced PrEP. The proportion of PrEP-covered days was 3320/3400 days (97.6%); 31/32 (96.9%) had regular HIV serology monitoring. The service was feasible to run, but it relied on outreach provision and liaison with other services.

DISCUSSION

Tailored PrEP services can reach PWID effectively. Uptake and adherence were high but the model was resource-intensive. Appropriately tailored PrEP delivery may be required to meet the needs of this and other key populations who experience barriers to accessing mainstream services.

The role of transport and telecommunications technology in the development of the Scottish Highlands and Islands Medical Service: a historical perspective

The Highlands and Islands Medical Service (HIMS) was introduced across the Scottish Highlands and Islands region after the publication of the Dewar Report in 1913. It was the first state-funded medical service in the UK and one of the first in the world. The Dewar Committee recommended the establishment of HIMS following research into healthcare provision in the region, concluding that there was insufficient provision. Among Dewar's major findings were the lack of sufficient transport infrastructure, high transport costs and low availability, and the lack of telecommunication services. This historical study with current relevance has addressed the contribution of transport and telecommunication technologies to the overall success of the Highland and Islands Medical Service. We have considered the crucial role of developments in the transport and telecommunications industries in overcoming contemporaneous healthcare problems. Through the study of contemporary letters, newspaper articles and government reports, this study assesses whether the views expressed at the time agree with the central contention that automobiles and telecommunication services were essential to the success of HIMS. This study also assesses the parallels drawn between the problems faced by HIMS in the 1900s and modern-day rural healthcare providers. Automobile use allowed those in the Highlands and Islands to commute with far greater ease, indirectly allowing doctors and members of the healthcare team to travel to see patients further afield and in greater numbers due to reduced travelling time. Additionally, funds provided by other government departments as well as HIMS allowed telecommunication technology to develop in the region, resulting in improved communication between widely dispersed healthcare workers, thereby improving healthcare provision. Prior to the formation of HIMS, the Highlands and Islands region in Scotland struggled to provide sufficient health care to its residents. The formation of HIMS resulted in improved health care in the region while simultaneous developments in the transport and telecommunication industries occurred. Past scholars have established links between the transport and telecommunication industries and healthcare provision in several countries. This study has contributed to existing literature by providing an insight into the relationship between such services in the Highlands and Islands region as well as rural life in the early 1900s. To conclude, the development of the transport and telecommunications industries acted synergistically with HIMS to lead to success in provision of good health care in the region.

Online Mindfulness May Target Psychological Distress and Mental Health during COVID-19

Background

The COVID-19 pandemic has dramatically affected mental health, creating an urgent need for convenient and safe interventions to improve well-being. Online mindfulness interventions show promise for improving depression, anxiety, and general well-being.

Objective

To assess: 1) the impact of online mindfulness on psychological distress, 2) altruistic efforts, and 3) the quantity, quality, and availability of online mindfulness resources during the COVID-19 pandemic.

Methods

233 participants (203 U.S.; 20 international; 10 unknown) participated in this prospective, single-arm, non-randomized clinical trial of a single online mindfulness meditation session with pre- and post-surveys.

Main Outcome Measures

(a) Mindfulness session helpfulness, online platform effectiveness, and immediate pre- to post-session changes in momentary stress, anxiety, and COVID-19 concern; (b) qualitative themes representing how people are helping others during the pandemic; (c) absolute changes in quantity of mindfulness-oriented web content and free online mindfulness resource availability from May to August 2020.

Results

Most participants felt the online mindfulness session was helpful and the electronic platform effective for practicing mindfulness (89%, 95% CI: [82 to 93%]), with decreased momentary anxiety (76%; 95% CI: [69 to 83%]), stress (80%; [72 to 86%]), and COVID-19 concern (55%; [46 to 63%]), (p < 0.001 for each measure). Participants reported helping others in a variety of ways during the pandemic, including following public health guidelines, conducting acts of service and connection, and helping oneself in hopes of helping others. "Mindfulness + COVID" search results increased by 52% from May to August 2020. Most (73%) Academic Consortium for Integrative Medicine and Health member websites offer free online mindfulness resources.

Conclusions

Virtual mindfulness is an increasingly accessible intervention available world-wide that may reduce psychological distress during this isolating public health crisis. Kindness and altruism are being demonstrated during the pandemic. The consolidated online mindfulness resources provided may help guide clinicians and patients.

Role of traditional healers in the pathway of service for a sample of obsessive compulsive disorder patients in Egypt

BACKGROUND

The diagnosis and treatment of an illness using traditional medicine is in most cases culture-specific and based on beliefs in the community. The majority of mentally ill patients prefer to attend to traditional healers because of the trust problems in the system, affordability, accessibility, and ease of the service.

AIM

To assess the role of traditional healers among the pathway of psychiatric services of OCD patients, and to highlight its clinical correlates.

METHODS

we assessed 93 patients with OCD after confirmation of the diagnosis with fifth version of MINI semi structured interview, using a questionnaire designed and accustomed by authors to assess help seeking behavior in OCD patients and its sociodemographic and clinical correlates. Type of symptomatology and its severity were assessed using Y-BOCS.

RESULTS

A total of 39.8% sought traditional healers help, 94.6% were before psychiatric advice, main symptoms related to traditional healers seeking were religious and sexual obsessions. Main causes of traditional healers' preference were stigma of seeking psychiatric advice in 89.2% of cases, considering disease related to religion in 81.1%, considering that religious commitment help in treatment 75, 7%, and considering disease related to magic and superstitions in 45.9%. Religious origin of illness was the most statistically significant factor related to seeking advice at traditional healers.

CONCLUSION

This study shows that a significant percentage of the patients suffering from OCD prefer to approach traditional healers first due to their own beliefs mainly religious, and society acceptance.

Healthcare Providers and Caregivers' Perspectives on the Quality of Child Health Services in Urban Indonesia: A Mixed-Methods Study

Although Indonesia’s child mortality rate has decreased in tandem with the global trend, healthcare services can be further improved for children. This study aims to explore the perceptions of healthcare providers and caregivers of children aged below five years to improve child health in urban Indonesia. A mixed-methods study design was adopted. Quantitative data were collected via questionnaires from the caregivers. Qualitative data were collected via semi-structured interviews from the healthcare providers. Analysis of 540 caregiver questionnaires regarding the care provided to their child revealed that the majority of them were very satisfied (46.1%) and satisfied (52.2%) with the care received. Analysis of 12 interviews with healthcare providers derived three major themes: (1) importance of one’s role as a healthcare provider; (2) factors affecting the delivery of healthcare; and (3) the way forward in caring for young children. Although caregivers were very satisfied with the care received for their children, the perception of healthcare providers regarding their responsibility in delivering care to children under five years old provides insights into improving the quality of services for children in Indonesia. Our findings suggest that mortality and morbidity of children aged below five years can be best reduced by optimizing primary and secondary preventive measures.

Effects of an Enhanced Training on Primary Care Providers Knowledge, Attitudes, Service and Skills of Dementia Detection: A Cluster Randomized Trial

Background: Effective training programs for primary care providers (PCPs) to support dementia detection are needed, especially in developing countries. This study aimed to investigate the effect of an enhanced training on the competency and service of PCPs for dementia detection.

Methods: We conducted a cluster randomized trial in Beijing, China. Community healthcare centers (CHCs) located in Fengtai or Fangshan District were eligible. The enrolled CHCs in each district were randomly assigned to the standard or the enhanced training group at a 1:1 ratio. PCPs serving older adults in enrolled CHCs were eligible to participate. The standard training group received three-hour didactic lectures, three monthly supervisions, 3 months of online support and dementia screening packages. The enhanced training group additionally received three monthly face-to-face supervisions and 3 months of online support. The participants became aware of their group membership at the end of the standard training. The knowledge, attitudes, service, and skills regarding dementia detection were assessed using questionnaires and submitted dementia detection records, respectively.

Results: A total of 23 and 21 CHCs were randomly assigned to the standard and the enhanced training group, respectively, and 58 participants from 20 CHCs assigned to the standard training group and 48 from 16 CHCs assigned to the enhanced training group were included in the final analysis (mean age 37.5 years, and 67.0% women). A significant increase in the knowledge score was found in both groups, but the increase was similar in the two groups (P = 0.262). The attitude score remained stable in both groups, and no between-group difference was found. Compared with the baseline, both groups reported an increase in dementia detection service, especially the enhanced training group (24.1% to 31.0% in the standard training group and 14.6% to 45.8% in the enhanced training group). The completion rate and accuracy of submitted dementia detection records in the enhanced training group were both significantly higher than those in the standard training group (both P < 0.001).

Conclusion: The enhanced training had similar effect on the knowledge of PCPs comparing with the standard training, but was better on continuous service and skills of PCPs related to dementia detection.

Trial registration:www.ClinicalTrials.gov, identifier: NCT02782000. Registration date: May 2016. The trial was completed in July 2017.