Whether and how people reach care.
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1151 to 1175 of 2,047A pilot digital intervention targeting loneliness in young people with psychosis.
Purpose: Loneliness has been identified as a significant challenge for people with psychosis. Interventions targeting loneliness are lacking but adopting a positive psychology approach may reduce loneliness, promote well-being, and support meaningful social interactions. Together with youth mental health consumers, we developed a digital smartphone application (app) called +Connect, which delivers positive psychology content daily for 6 weeks.
Materials and methods: Twelve participants diagnosed with a psychotic disorder were recruited from early psychosis services. Loneliness was assessed pre-intervention, post-intervention, and 3-month post-intervention. Acceptability, feasibility, and usability were measured post-intervention, including a semi-structured interview on the user's experience of +Connect.
Results: We found evidence for the feasibility of +Connect. All but two participants…
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Xia Y, Xu L, Sun L, Li J, Qin W, Zhang J, Wang Y, Jing X, Lu L, Li Y, Jiao A (2020)MEDLINE-indexed journal, not yet read by usInternational journal for quality in health care : journal of the International Society for Quality in Health Care16 citations Rural-urban differences in home-based care willingness among older adults: A cross-sectional study in Shandong, China.
Objective: To examine the rural-urban disparities of home-based care willingness among older adults and identify the influencing factors.
Design: A cross-sectional study.
Setting: The data used in this cross-sectional study were conducted in Shandong province.
Study participants: 7070 older adults (60 years and older) with complete data were included in this analysis from the 2017 Survey of the Shandong Elderly Family Health Service.
Intervention: N/A.
Main outcome measure: The data were analyzed using logistic regression models to examine whether socio-demographic characteristic, physical health, loneliness score and other factors were associated with home-based care willingness in rural and urban older adults. After exploring the factors, we compared the difference.
Results: Of 7070 participants, 66.9% were rural older adults and 33.1% were urban. The urban older adults less likely cho…
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Impact of rural Family Physician programme on maternal and child health indicators in Iran: an interrupted time series analysis.
Objectives: The establishment of the Family Physician (FP) programme in the rural areas of Iran in 2005 has made health services accessible and affordable. This paper aims to assess the overall trends of maternal and child health (MCH) indicators in a 20-year period and possible effects of the FP programme (intervention) on these indicators in Iran.
Design and setting: An interrupted time series analysis was conducted on 20 annual MCH-related data points from 1994 to 2013. The intervention time was at the 12th data point in 2005.
Outcomes: MCH indicators were grouped into three categories: structure (mother's age, education, occupation and gravidity), process (number of antenatal care visits (ACVs), laboratory tests, ultrasounds and natural vaginal deliveries (NVDs)) and outcomes (maternal mortality ratio (MMR), neonatal mortality rate (NMR), birth weight (BW), history of abortion and/or…
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Are perceived barriers to accessing mental healthcare associated with socioeconomic position among individuals with symptoms of depression? Questionnaire-results from the Lolland-Falster Health Study, a rural Danish population study.
Objective: To evaluate if perceived barriers to accessing mental healthcare (MHC) among individuals with symptoms of depression are associated with their socio-economic position (SEP).
Design: Cross-sectional questionnaire-based population survey from the Lolland-Falster Health Study (LOFUS) 2016-17 of 5076 participants.
Participants: The study included 372 individuals, with positive scores for depression according to the Major Depression Inventory (MDI), participating in LOFUS .
Interventions: A set of five questions on perceived barriers to accessing professional care for mental health problem was posed to individuals with symptoms of depression (MDI score >20).
Outcomes: The association between SEP (as measured by educational attainment, employment status and financial strain) and five different types of barriers to accessing MHC were analysed in separate multivariable logistic regres…
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Perceived barriers to accessing Female Community Health Volunteers' (FCHV) services among ethnic minority women in Nepal: A qualitative study.
Despite the efforts of community health workers to increase access to healthcare among ethnic minority groups in low- and -middle income countries, members of ethnic minorities are less likely than women from other ethnic groups to use maternal and child healthcare services. However, much less is known about the factors that limit access of ethnic minorities to healthcare services, including the services of community health workers in Nepal, who are known as Female Community Health Volunteers (FCHVs). To address this issue, we conducted a qualitative study to explore perceived barriers to accessing maternal and child healthcare services among ethnic minority groups in two different geographical locations (the hill and Terai regions- flatland bordering south India) with varying degrees of access to local healthcare centres. Between April 2014 and September 2014, semi-structured interviews…
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Marques A, Jácome C, Rebelo P, Paixão C, Oliveira A, Cruz J, Freitas C, Rua M, Loureiro H, Peguinho C, Marques F, Simões A, Santos M, Martins P, André A, De Francesco S, Martins V, Brooks D, Simão P (2019)MEDLINE-indexed journal, not yet read by usBMC public health30 citations Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysis.
Background: Pulmonary rehabilitation (PR) has demonstrated patients' physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit.
Methods: A 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patient-caregivers) will compose the experimental group. The control group will include dyads age- and disease-matched will…
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Multimorbidity, healthcare utilization and socioeconomic status: A register-based study in Denmark.
Background: People with multimorbidity have reduced functional capacity, lower quality of life, higher mortality rates and use healthcare resources more intensively than healthy people or those with a single chronic condition. Multimorbidity was defined as the coexistence of two or more chronic conditions in the same person. The aim of this study was to explore associations between multimorbidity and use of healthcare services and the impact of socioeconomic status on utilization of hospitalizations and bed days.
Methods: The study population included all individuals aged 16 years and older who lived in the Capital Region of Denmark on January 1st, 2012. Data on chronic conditions, use of healthcare services and demographics were obtained from Danish national administrative and health registries. Zero-inflated models were used to calculate anticipated annual use of hospitalizations and b…
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Exploring English speaking Muslim women's first-time maternity experiences: a qualitative longitudinal interview study.
Background: Muslim women of child-bearing age make up a fair part of the UK society, however, literature addressing their health needs or experiences of health services have not been extensively researched. The term 'Muslim' is often combined with ethnic group identity, rather than used to refer to people distinguished by beliefs or affiliations. Muslim women commonly observe certain religious and cultural practices during their maternity journey. The little research there is in this area suggests that more could be done from a service provision perspective to support Muslim women through this significant life event. The aim of this study was to investigate Muslim women's perceived needs and the factors that influence their health seeking decisions when engaging with maternity services located in North-West of England.
Methods: The study used longitudinal semi-structured interviews with …
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Factors influencing the use of reproductive health care services among married adolescent girls in Dang District, Nepal: a qualitative study.
Background: Child marriage is associated with adverse reproductive health outcomes, and the practice is still alarmingly common. Together with efforts to end child marriage, it is essential to provide adequate health care to already married adolescents. However, to date there has been very limited research on health care-seeking practices among married adolescents in Nepal.
Method: The study was conducted in a rural part of Dang District situated in the Mid-western region of Nepal. We combined thirteen individual interviews and four focus group discussions with 17-20 years old women who had married before the age of 18 years and individual interviews with 10 key informants.
Results: Pressure to give birth early, limited autonomy, and little knowledge about reproductive health issues make married adolescents vulnerable to risky pregnancies. Early-married women face a range of barriers to …
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Health Disparities among Children with Autism Spectrum Disorders: Analysis of the National Survey of Children's Health 2016.
Utilizing the 2016 National Survey of Children's Health, this study illustrates that children with ASD have nearly 4 times higher odds of unmet health care needs compared to children without disabilities, whereas children with other disabilities had nearly 2 times higher odds of unmet health care needs compared to children without disabilities. Applying Andersen's Behavioral Model of health care utilization, this study estimates that enabling factors (e.g., access to health insurance, quality of health insurance, access to family-centered care, family-level stress, exposure to adverse childhood experiences, and parental employment) improved prediction of regression model for unmet health care needs by 150%. Policy and program implications are discussed and a new framework for responding to observed disparities is discussed.
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Intact goal-directed control in treatment-seeking drug users indexed by outcome-devaluation and Pavlovian to instrumental transfer: critique of habit theory.
Animal studies have demonstrated that chronic exposure to drugs of abuse impairs goal-directed control over action selection indexed by the outcome-devaluation and specific Pavlovian to instrumental transfer procedures, suggesting this impairment might underpin addiction. However, there is currently only weak evidence for impaired goal-directed control in human drug users. Two experiments were undertaken in which treatment-seeking drug users and non-matched normative reference samples (controls) completed outcome-devaluation and specific Pavlovian to instrumental transfer procedures notionally translatable to animal procedures (Experiment 2 used a more challenging biconditional schedule). The two experiments found significant outcome-devaluation and specific Pavlovian to instrumental transfer effects overall and there was no significant difference between groups in the magnitude of these…
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Short birth interval and associated factors among women of child bearing age in northern Ethiopia, 2016.
Background: Short birth interval is known to have a negative effect on perinatal, neonatal and child health outcomes. In Ethiopia, 29% of births are short birth intervals at less than 24 months. Even though optimum birth spacing is considered as an essential factor for the health of women and their children, to the best of the authors' knowledge studies conducted on short birth interval are insufficient to inform policy makers. Therefore, the aim of this study was to assess short birth interval and associated factors among women of child bearing age in Tigray, Ethiopia.
Methods: A community based cross-sectional study was conducted in Tselemti district among women of child bearing age from January 28 to February 28, 2016. Systematic sampling technique was used to select participants. Data were collected through face to face interviews and analyzed using SPSS version 20.0. Odds ratio alon…
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Evaluation of the acceptability and clinical utility of an Arabic-language mindfulness CD in an Australian community setting.
The cultural, linguistic, and religious diversity of Australia's population presents challenges for mental health service delivery. Arabic-speaking communities in Australia underutilise mental health services despite high levels of trauma and psychological distress. Clinicians who work with this population lack linguistically and culturally appropriate clinical resources. The aim of this study was to explore the acceptability and clinical utility of a Mindfulness Skills CD translated into formal Arabic. The 70 participants were Arabic-speaking adults, mostly Lebanese-born Muslim women, who enrolled in a 5-week mindfulness program using the CD and agreed to follow-up at 12 weeks. Both recruitment and data collection were undertaken by a female project officer who is a widely respected member of the Arabic community in south-east Sydney. Compliance with the program protocol was high and al…
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Supporting access to healthcare for refugees and migrants in European countries under particular migratory pressure.
Background: In 2015 the increased migratory pressure in Europe posed additional challenges for healthcare providers. The aim of this study was to inform the development of a "Resource Package" to support European Union (EU) member states in improving access to healthcare for refugees, asylum seekers and other migrants.
Methods: A mixed method approach was adopted: i) interviews and focus groups were carried out to gather up-to-date information on the challenges the different healthcare providers were facing related to the refugee crisis; ii) to complement the results of the FGs, a literature review was conducted to collect available evidence on barriers and solutions related to access to healthcare for refugees and migrants.
Results: The different actors providing healthcare for refugees and migrants faced challenges related to the phases of the migration trajectory: arrival, transit and…
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A model exploring the relationship between betrayal trauma and health: The roles of mental health, attachment, trust in healthcare systems, and nonadherence to treatment.
Objective: Prior research suggests that there is a relationship between traumatic experiences and poor health. When considered through the lens of betrayal trauma (i.e., the perpetrator and the victim have a close interpersonal relationship), traumatic experiences predict greater posttraumatic difficulty and higher levels of depression. Betrayal trauma has been associated with poorer interpersonal relationships and less trust in individuals and systems that may be important for a person's wellbeing, such as health care systems. In turn, trauma survivors are less likely to adhere to medical treatment, which may ultimately affect their overall health. The current study examined the complex relationship between experiences of betrayal trauma and poor health, while accounting for demographics, mental health symptoms, trust in physicians and the medical system, attachment style, and nonadhere…
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The association between voluntary work and health care use among older adults in Germany.
Objective: While most studies focused on the relation between volunteering and health-related outcomes, little attention has been given on the association between volunteering and the use of health care services. Thus, with this analysis we aimed at exploring whether and how the voluntary work of older adults is related to the utilization of health care services in Germany.
Methods: The analysis was based on data from the German Ageing Survey (DEAS), a nationally representative, longitudinal study of the German population aged 40 years and older. Focusing on volunteering, data from the waves 2002, 2008 and 2011 was used. Voluntary work in groups and organizations (yes/no) was used as explanatory variable. To quantify health care utilization, visits to general practitioners and specialists as well as nights in the hospital in the past 12 months were used. Fixed effects regressions were ap…
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Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J, Thome J, Dom G, Kasper S, Nunes Filipe C, Stes S, Mohr P, Leppämäki S, Casas M, Bobes J, Mccarthy JM, Richarte V, Kjems Philipsen A, Pehlivanidis A, Niemela A, Styr B, Semerci B, Bolea-Alamanac B, Edvinsson D, Baeyens D, Wynchank D, Sobanski E, Philipsen A, McNicholas F, Caci H, Mihailescu I, Manor I, Dobrescu I, Saito T, Krause J, Fayyad J, Ramos-Quiroga JA, Foeken K, Rad F, Adamou M, Ohlmeier M, Fitzgerald M, Gill M, Lensing M, Motavalli Mukaddes N, Brudkiewicz P, Gustafsson P, Tani P, Oswald P, Carpentier PJ, De Rossi P, Delorme R, Markovska Simoska S, Pallanti S, Young S, Bejerot S, Lehtonen T, Kustow J, Müller-Sedgwick U, Hirvikoski T, Pironti V, Ginsberg Y, Félegyházy Z, Garcia-Portilla MP, Asherson P (2019)MEDLINE-indexed journal, not yet read by usEuropean psychiatry : the journal of the Association of European Psychiatrists378 citations Updated European Consensus Statement on diagnosis and treatment of adult ADHD.
Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, g…
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Large-Scale Dissemination of Internet-Based Cognitive Behavioral Therapy for Youth Anxiety: Feasibility and Acceptability Study.
Background: Internet-based cognitive behavioral therapy (iCBT) for child and adolescent anxiety has demonstrated efficacy in randomized controlled trials, but it has not yet been examined when disseminated as a public health intervention. If effective, iCBT programs could be a promising first-step, low-intensity intervention that can be easily accessed by young people.
Objective: The objective of our study was to examine the feasibility and acceptability of a publicly available online, self-help iCBT program (BRAVE Self-Help) through exploration of program adherence, satisfaction, and changes in anxiety.
Methods: This study was an open trial involving the analysis of data collected from 4425 children and adolescents aged 7-17 years who presented with elevated anxiety at registration (baseline) for the iCBT program that was delivered through an open-access portal with no professional supp…
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Patient-Sharing Networks of Physicians and Health Care Utilization and Spending Among Medicare Beneficiaries.
Importance: Physicians are embedded in informal networks in which they share patients, information, and behaviors.
Objective: We examined the association between physician network properties and health care spending, utilization, and quality of care among Medicare beneficiaries.
Design, setting, and participants: In this cross-sectional study, we applied methods from social network analysis to Medicare administrative data from 2006 to 2010 for an average of 3 761 223 Medicare beneficiaries per year seen by 40 241 physicians practicing in 51 hospital referral regions (HRRs) to identify networks of physicians linked by shared patients. We improved on prior methods by restricting links to physicians who shared patients for distinct episodes of care, thereby excluding potentially spurious linkages between physicians treating common patients but for unrelated reasons. We also identified natur…
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Social media use and influenza vaccine uptake among White and African American adults.
Influenza vaccination rates in the U.S. remain low at 41% among adults over 18 years according to the Centers for Disease Control and Prevention's 2016 data. Reasons for the low rate vary and include factors such as risk perception, vaccine hesitancy, and access to health care. This cross-sectional study sought to examine the relationship between social media use and influenza vaccine uptake among a sample of White and African Americans over 18 years of age. Using bivariate, and unadjusted and adjusted logistic regression tests, this study examined the relationship among social media use, social media as a source of health information, and influenza vaccination status in 2015. Our results indicate that users of Twitter (OR4.41, 95%CI: 1.43-13.60) and Facebook (OR 1.66, 95%CI: 1.01-2.72) as sources of health information were more likely to be vaccinated in comparison to users who do not u…
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Insights from the design and implementation of a single-entry model of referral for total joint replacement surgery: Critical success factors and unanticipated consequences.
Background: Single-entry models (SEMs) in healthcare allow patients to see the next-available provider and have been shown to improve waiting times, access and patient flow for preference-sensitive, scheduled services. The Winnipeg Central Intake Service (WCIS) for hip and knee replacement surgery was implemented to improve access in the Winnipeg Regional Health Authority. This paper describes the system's design/implementation; successes, challenges, and unanticipated consequences.
Methods: On two occasions, during and following implementation, we interviewed all members of the WCIS project team, including processing engineers, waiting list coordinators, administrators and policy-makers regarding their experiences. We used semi-structured telephone interviews to collect data and qualitative thematic analysis to analyze and interpret the findings.
Results: Respondents indicated that the …
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Social dimensions of health across the life course: Narratives of Arab immigrant women ageing in Canada.
The increase in ethnically and linguistically diverse older adults in Canada necessitates attention to their experiences and needs for healthy ageing. Arab immigrant women often report challenges in maintaining health, but little is known about their ageing experiences. This interpretive descriptive study uses a transnational life course framework to understand Arab Muslim immigrant women's experiences of engaging in health-promoting practices as they age in Canada. Women's stories highlight social dimensions of health such social connectedness, social roles and social support that are constructed and maintained within different migration contexts across the life course. Barriers and facilitators to healthy ageing in this population centred around five themes: (i) the necessity of staying strong, (ii) caring for self while caring for others, (iii) double jeopardy of chronic illnesses and…
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Acceptability, tolerability, and potential efficacy of cognitive behavioural therapy for Insomnia Disorder subtypes defined by polysomnography: A retrospective cohort study.
In this retrospective cohort study, we describe acceptability, tolerability and potential efficacy of cognitive behavioural therapy (CBT) in Insomnia Disorder subtypes, derived from polysomnography (PSG): insomnia with normal-sleep duration (I-NSD) and insomnia with short-sleep duration (I-SSD). All research volunteers were offered access to digital CBT, single component sleep restriction therapy and face-to-face group CBT. Follow-up occurred at three months post-treatment using the insomnia severity index (ISI). 96 participants (61 females, mean age of 41 years) were grouped into either normal-sleep (n = 53) or short-sleep (n = 43). CBT was acceptable to 63% of participants (normal-sleep = 31, short-sleep = 29), with 28 completing therapy (tolerability: normal-sleep = 11, short-sleep = 17). For potential efficacy, 39 (normal-sleep = 20, short-sleep = 19) out of 96 participants (41%) com…
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Lesbian, Gay, And Bisexual Adults Report Continued Problems Affording Care Despite Coverage Gains.
The uninsurance rate among lesbian, gay, and bisexual (LGB) adults has dropped since the Affordable Care Act (ACA) and legalization of same-sex marriage. Less is known about whether disparities in access to care and health outcomes have narrowed in LGB adults compared to their straight peers in the post-ACA era. We used data from three waves of the Behavioral Risk Factor Surveillance System to examine access to a personal doctor, affordability of care, type of health insurance coverage, and self-reported health in LGB adults in the period January 2014-February 2017 in thirty-one states that implemented the system's sexual orientation module. Compared to straight adults, more LGB adults reported avoiding necessary care because of cost and worse self-reported health outcomes, even if they had health insurance. More LGB adults reported having individually purchased insurance, which suggests…
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Implementation of a psychosocial support package for people receiving treatment for multidrug-resistant tuberculosis in Nepal: A feasibility and acceptability study.
Background and objectives: People receiving treatment for multidrug-resistant tuberculosis (MDR-TB) have high rates of depression. Psychosocial support in general, and treatments for depression in particular, form an important but neglected area of patient-centred care, and a key pillar in the global End TB strategy. We assessed the feasibility and acceptability of a psychosocial support package for people receiving treatment for MDR-TB in Nepal.
Methods: This feasibility study used a mixed quantitative and qualitative approach. We implemented the intervention package in two National Tuberculosis Programme (NTP) MDR-TB treatment centres and 8 sub-centres. We screened patients monthly for depression and anxiety (cut-off ≥24 and ≥17 respectively on the Hopkins Symptom Checklist) and also for low social support (cut-off ≤3 on the Multidimensional Scale of Perceived Social Support). Those wh…
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