Women's expectations of healthcare professionals in case of intimate partner violence in Serbia.

Women who have experienced intimate partner violence use health care services more often than non-abused women, but it is unclear what they expect from physicians in relation to their intimate partner violence experience. In this study the authors explored whether women in Serbia expect physicians to help them after having experienced intimate partner violence, what kind of help the women expected, and if none, why none is expected. The authors of this study conducted structured interviews with 120 women who visited six primary healthcare centres. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed applying content analyses. The majority of women (81.7%) expected healthcare professionals to help them in the event of intimate partner violence, mainly through giving advice, information, contacting other institutions, services, and providing understanding and support. Fewer women expected help in the form of documenting violence and contacting police. Only a minority (8.3%) did not expect help, noting that intimate partner violence is beyond the scope of healthcare professionals' interest or competencies, and/or that violence was a private problem, while 10% were unsure about the role of physicians in the case of intimate partner violence. The majority of women in this study expected help with intimate partner violence. Physicians should be aware of these expectations and how to provide support to women experiencing intimate partner violence.

Sleep Quality Assessment in Adolescents with and without Type 1 Diabetes Using the Pittsburg Sleep Quality Index.

BACKGROUND AND AIMS: Many diseases, especially chronic diseases, can lead to sleep disturbances. Our study aimed to evaluate sleep characteristics and the relationship between sleep disorders and diabetes-related variables in type 1 diabetes adolescents and to compare these results with a non-diabetic group of similar age and gender. METHODS: This cross-sectional study collected data from 40 healthy adolescents and 50 patients of the same age group with type 1 diabetes mellitus from January 2019 to June 2019. Subjects were asked to complete the Pittsburgh Uyku Kalitesi Anketi (PUKA). Patients who had nocturnal hypoglycemia in the preceding one month were excluded. RESULTS: Total scores for PUKA were not significantly different between the two groups (P = 0.197). No significant relationship was found between sleep quality, duration of diabetes, and HbA1c levels in the diabetes group (P = 0.59, P = 0.41, respectively). Poor sleep quality (PUKA score ≥5) in girls without diabetes was higher (95% confidence interval: 1.26-11.61) than in the diabetes group (P = 0.031). CONCLUSION: In our study, the prevalence of sleep disorders in T1D patients was not higher than the non-diabetic population. However, the girls in the non-diabetic group had significant poor sleep quality. We hypothesize that this may be due to diabetes management bringing order and discipline to an adolescents life.

Implementation of diversity in healthcare practices: barriers and opportunities.

OBJECTIVE: The aim of this study is to investigate to which extent diversity is part of current healthcare practices and to explore opportunities and barriers in the implementation of diversity dimensions in healthcare practices. METHODS: Nine in-depth, semi-structured interviews and three focus groups were conducted in three healthcare settings (mental health, hospital, nursing home care). RESULTS: Results demonstrate that (the potential of) diversity is an ambiguous issue; diversity is said to be important, but this has not led to adjustments of the neutral, disease-oriented approach of patients. If recognized at all, diversity is reduced to one dimension (sex). Barriers in the implementation of diversity relate to: (a) lacking awareness and knowledge of diversity, (b) poor information and communication, and (c) organizational constraints. Opportunities to implement diversity in healthcare include: (d) an emerging sense of urgency to attend to diversity, (e) the development of good practices, and (f) the political climate. CONCLUSION: Various barriers and some opportunities for the implementation of diversity in healthcare practices have been identified. There is an ambiguity in how professionals deal with diversity. As a result, the neutral approach remains dominant in practice and policy. PRACTICE IMPLICATIONS: In order to raise the awareness and enhance the competence of professionals, educational programmes and learning networks are required.

Gender sensitivity among general practitioners: results of a training programme.

BACKGROUND: Gender differences contribute to patients' health and illness. However in current healthcare practices attention to gender differences is still underdeveloped. Recognizing these differences and taking them into account can improve the quality of care. In this study we aimed to investigate whether GPs' gender sensitivity can be stimulated by a training programme. The focus was on three diseases: angina pectoris, depression and urinary incontinence. METHODS: This study had a quantitative, explorative and descriptive design. By means of a training programme 18 GPs were trained to focus on gender-sensitive recommendations for the three diseases. With standardised registration forms, data were collected during a 6-month period. During the registration period, the GPs were visited by the study team to discuss the process of data collection. RESULTS: The GPs filled in registration forms for 100 patients: 39 with angina pectoris (31 women and 8 men), 40 with depression (26 women and 14 men), and 21 with urinary incontinence (20 women and 1 man). The results show that gender sensitivity can be stimulated among trained professionals. The combination of the training programme, clear and practical recommendations, daily discussion of relevant cases between the GP couples, feedback and support during registration by the study team probably contributed to the outcome. CONCLUSION: GPs' gender sensitivity was stimulated by the training programme and the supporting visits. Ideally, structural attention could be realised by embedding gender issues in existing organisational structures of general practices.

Long-term effects of bilateral subthalamic nucleus stimulation in advanced Parkinson disease: a four year follow-up study.

In this study we aimed to investigate the effects of bilateral STN HFS in patients with advanced Parkinson disease (PD) at long-term, with a minimum follow-up of 4 years. Twenty patients (15 men, five women) were included, with a mean age of 60.9+/-8.1 years. Surgery was performed under local anesthesia. The target was defined on computerized tomography (CT). At 3 months, significant improvements were found on the total Unified Parkinson disease rating scale (UPDRS) III (motor) score, in the medication. off (from 42.3+/-9.3 to 19.5+/-6.4), as well as the medication on (from 18.6+/-12.1 to 10.1+/-5.9) phase. The UPDRS IVa (dyskinesias) and IVb (motor fluctuations) scores decreased significantly. At long-term follow-up, there were still significant improvements on the total UPDRS III motor score (from 42.3+/-9.3 to 24.2+/-13.2), as well as in all motor subscores, in the off phase, during stimulation. In the on phase, the only significant improvement was seen for rigidity. Complications included hypomania to mania in four patients. Our results indicate that HFS STN results in long-lasting improvement of the motor symptoms, ADL activities and functional performance in patients suffering from advanced PD. The stimulation induced behavioural changes need special consideration.

Long-term motor effect of unilateral pallidal stimulation in 26 patients with advanced Parkinson disease.

OBJECT: The aim of this study was to evaluate the long-term effects of unilateral pallidal stimulation on motor function in selected patients with advanced Parkinson disease (PD). METHODS: The authors enrolled 26 patients with idiopathic PD in whom there was an asymmetric distribution of symptoms and, despite optimal pharmocological treatment, severe response fluctuations and/or dyskinesias. After the patient had received a local anesthetic agent, a quadripolar electrode (Medtronic model 3387) was implanted at the side opposite the side affected or, if both sides were affected, the side contralateral to the more affected side. No serious complications occurred. After 3 months, the total Unified PD Rating Scale (UPDRS) Part III score decreased by 50.7% while patients were in the off-medication state (from 26.5 +/- 9.2 to 13.1 +/- 6.1) and by 55.4% while they were in the on-medication state (from 10.6 +/- 6.3 to 4.7 +/- 4.4). Only during the on state was the contralateral effect clearly more pronounced. The UPDRS Part IVa score decreased by 75% (from 3.7 +/- 2.5 to 0.9 +/- 1.1) and the UPDRS Part IVb score by 54.7% (from 3.3 +/- 1.3 to 1.5 +/- 1.3). At long-term follow-up review (32.7 +/- 10.7 months), there was an 8.3% increase in the UPDRS Part III score while patients were in the off state (from 26.5 +/- 9.2 to 28.7 +/- 7.6) and a 40.2% increase in this score while patients were in the on state (from 10.6 +/- 6.3 to 14.9 +/- 5.1). The UPDRS Part IVa score decreased by 28.1% (from 3.7 +/- 2.5 to 2.7 +/- 2.3) and the UPDRS Part IVb score increased by 3.5% (from 3.3 +/- 1.3 to 3.4 +/- 1.6). CONCLUSIONS: Based on these unsatisfactory results at long-term review, the authors conclude that unilateral pallidal stimulation is not an effective treatment option for patients with advanced PD.

Process evaluation of a diversity training program: the value of a mixed method strategy.

Patients' health and health needs are influenced by categories of difference like sex, gender, ethnic origin and socioeconomic status (SES). To enhance awareness of this diversity among patients and to provide holistic care for them, health professionals should first be aware of the relation between dimensions of diversity and patients' health and health demands. This paper presents a formative process evaluation of a diversity sensitivity training programme for healthcare professionals. The training was implemented in three healthcare settings (mental healthcare, nursing home and hospital care). Mixed methods were used to monitor the implementation of the training and its effects after three years. Findings demonstrate that the training stimulated participants' awareness, knowledge and critical attitudes towards diversity. Their motivation and willingness to take action regarding diversity was also enhanced. Yet these developments were less apparent among nursing home participants who felt less satisfied and did not develop a critical perspective on this issue. Qualitative data were helpful to explain differences between the settings. By means of the combination of quantitative and qualitative data, we can conclude that individual learning was not enough to guarantee a sensitive approach to diversity at the organizational level.

Bringing gender sensitivity into healthcare practice: a systematic review.

OBJECTIVE: Despite the body of literature on gender dimensions and disparities between the sexes in health, practical improvements will not be realized effectively as long as we lack an overview of the ways how to implement these ideas. This systematic review provides a content analysis of literature on the implementation of gender sensitivity in health care. METHODS: Literature was identified from CINAHL, PsycINFO, Medline, EBSCO and Cochrane (1998-2008) and the reference lists of relevant articles. The quality and relevance of 752 articles were assessed and finally 11 original studies were included. RESULTS: Our results demonstrate that the implementation of gender sensitivity includes tailoring opportunities and barriers related to the professional, organizational and the policy level. As gender disparities are embedded in healthcare, a multiple track approach to implement gender sensitivity is needed to change gendered healthcare systems. CONCLUSION: Conventional approaches, taking into account one barrier and/or opportunity, fail to prevent gender inequality in health care. For gender-sensitive health care we need to change systems and structures, but also to enhance understanding, raise awareness and develop skills among health professionals. PRACTICE IMPLICATIONS: To bring gender sensitivity into healthcare practice, interventions should address a range of factors.

Health professionals' perceptions of intimate partner violence against women in Serbia: opportunities and barriers for response improvement.

OBJECTIVE: The aim of this study was to determine the perceptions and attitudes of health professionals toward violence against women in intimate relationships, and to discuss them as opportunities and barriers for improving health professionals' response. METHODS: Six focus groups were conducted with 71 health professionals employed in the public primary health care centers in Belgrade (Serbia). The data were analyzed according to the direct approach of the qualitative content analysis. RESULTS: Findings suggest that the majority of health professionals perceive IPV as an unjustifiable act. They showed an understanding for women; see their role as providing support to women and collaborating with other institutions. They are willing to help, but do not know how. However, some health professionals appeared to be judgmental in terms of what preceded violence, and would insist on extracting a woman's disclosure that violence had occurred. As barriers, they emphasized the lack of training and specific education on IPV, a weak support network, and overall social insecurity. CONCLUSION: There is a gap between health professionals' willingness to help and resources needed, along with prejudice and interrogative attitudes. Barriers appeared at individual, organizational and societal levels. PRACTICE IMPLICATIONS: Proper education and protocols are priorities in strengthening health professionals' response to IPV.

Maintaining gender sensitivity in the family practice: facilitators and barriers.

OBJECTIVE: This study aims to identify the facilitators and barriers perceived by General Practitioners (GPs) to maintain a gender perspective in family practice. METHODS: Nine semi-structured interviews were conducted among nine pairs of GPs. The data were analysed by means of deductive content analysis using theory-based methods to generate facilitators and barriers to gender sensitivity. RESULTS: Gender sensitivity in family practice can be influenced by several factors which ultimately determine the extent to which a gender sensitive approach is satisfactorily practiced by GPs in the doctor-patient relationship. Gender awareness, repetition and reminders, motivation triggers and professional guidelines were found to facilitate gender sensitivity. On the other hand, lacking skills and routines, scepticism, heavy workload and the timing of implementation were found to be barriers to gender sensitivity. CONCLUSION: While the potential effect of each factor affecting gender sensitivity in family practice has been elucidated, the effects of the interplay between these factors still need to be determined.