Expectativas en salud de las personas mayores que acuden a la atención primaria / Health expectations of older people attending primary care

INTRODUCCIÓN: Desde la última década se ha evidenciado el aumento de la población de personas mayores en Chile. Muchos de ellos son usuarios regulares del sistema público de salud el cual se caracteriza por entregar una atención de tipo integral. En este sentido, resulta relevante conocer los requerimientos en salud desde la perspectiva de las experiencias de las personas mayores con respecto al uso de este servicio. OBJETIDO: El objetivo de este estudio fue identificar las expectativas de las personas mayores que asisten a los centros de APS. MATERIAL Y MÉTODOS: Este es un estudio cualitativo, descriptivo, donde la muestra fue de 13 personas mayores de 65 años y más, autovalentes, de tres centros APS, los cuales fueron entrevistados mediante instrumento semiestructurado, con análisis cualitativo de datos método que incluyó codificación abierta y focalizada. RESULTADOS: Las expectativas de las personas mayores fueron categorizadas como requerimiento de una atención profesional integral, oportunidad de atención, accesibilidad de la atención, promoción de salud sobre el autocuidado, explicación de cambios en el envejecimiento con enfoque biológico y alfabetización en salud. CONCLUSIONES: Las expectativas de las personas mayores en este estudio dan cuenta de una atención profesional integral poco efectiva, además de la necesidad de un trato especializado al grupo poblacional específico, no sólo de los profesionales, sino también del personal administrativo de los centros de APS, considerándolos una barrera en la calidad de la atención.

INTRODUCTION: Since the last decade there has been evidence of an increase in the population of older people in Chile. Many of them are regular users of the public health system (PHS) which is characterized by providing comprehensive care. In this sense, it is relevant to know the health requirements from the perspective of the experiences of the older people regarding the use of this health service. OBJECTIVE: The objective of this study was to identify the needs and expectations of older people attending PHS centers. MATERIAL AND METHODS: It were a qualitative and descriptive study. The sample was compounded by 13 people over 65 years and over, self-sufficient, from three PHS centers. It was used a semi-structured instrument. RESULTS: The main needs of the elderly were categorized as a requirement for comprehensive professional care, the opportunity for care, accessibility of care, health promotion on self-care, explanation of changes in aging with a biological focus and health literacy. CONCLUSIONS: The needs and expectations of the older people in this study account for an ineffective comprehensive professional care, in addition to the need for specialized treatment of the specific population group, not only of professionals but also of the administrative staff of the centers of PHS, considering them a barrier in the quality of care.

Impact of Culture, Spirituality, and Mental Health Attitudes on Intergenerational Asian-American Caregivers: A Pilot Study.

IMPORTANCE: Asian-Americans are more likely than other ethnic groups to care for older family members and less likely to seek mental health services. The research on caregiver burden among Asian-American intergenerational caregivers is limited. OBJECTIVE: To investigate how spirituality and mental health help-seeking attitudes correlate with and predict perceived feelings of caregiver burden among Asian-American caregivers. Favorable mental health help-seeking attitudes were predicted to negatively correlate with caregiver burden, and spirituality was predicted to negatively correlate with and negatively predict caregiver burden. DESIGN: Quantitative survey research. SETTING: Community mental health. PARTICIPANTS: One hundred one participants were recruited using the following inclusion criteria: Asian-Americans who currently or previously provided care to an Asian family member at least one generation older than the caregiver for at least 1 mo and in the past 3 yr. Outcomes and Measures: Items from the Burden Scale for Family Caregivers, Spirituality Scale, Expressions of Spirituality Inventory-Revised, Mental Help Seeking Attitudes Scale, and Self-Stigma of Seeking Psychological Help measured caregiver burden, spirituality, and mental health help-seeking attitudes. RESULTS: A statistically significant negative correlation was found between caregiver burden and spirituality and between caregiver burden and mental health help-seeking attitudes. Spirituality and number of domains of care were statistically significant predictors of caregiver burden. CONCLUSIONS AND RELEVANCE: Spirituality was found to negatively predict caregiver burden among Asian-American intergenerational caregivers. Mental health help-seeking attitudes were negatively correlated with caregiver burden. Occupational therapy practitioners have the opportunity to integrate spirituality and culturally sensitive mental health promotion into their services to Asian-Americans. What This Article Adds: Evidence that spirituality is a negative predictor of caregiver burden for Asian-American intergenerational caregivers offers a unique opportunity for occupational therapy practitioners to offer alternative methods of mental health promotion with this population. Understanding that spirituality and mental health help-seeking attitudes are culturally mediated allows practitioners to be informed about a dynamic in Asian-American culture.

Cultural Health Beliefs and Practices Among Hispanic Parents.

Parents' beliefs about and approaches to their child's health vary with culture and change within cultures over time. To provide an updated understanding of folk and traditional medicine (FTM) among Hispanic parents in the United States, we surveyed 200 caregivers identifying their child as Hispanic in a pediatric primary care clinic about their cultural health beliefs and practices. Overall, 84% of participants believed in ≥1 folk illness, with foreign-born participants more likely than US-born to endorse folk illness beliefs. Eighty-three percent had used cultural remedies for their children. Of those, although just 15% had discussed such practices with their child's provider, 86% would feel comfortable doing so. No demographic factors predicted use of cultural remedies/healers or comfort talking to providers. Beliefs and practices related to FTM are prevalent among Hispanic parents and cannot be predicted using demographics; providers should routinely ask all families about FTM.

Using the patient-acceptable symptom state to evaluate patients' perspectives of living with psoriasis: A cross-sectional study.

BACKGROUND: Taking the perspectives of patients into consideration is of the utmost importance when defining treatment goals for psoriasis. The patient-acceptable symptom state (PASS) is a dichotomised question that captures patients' perceptions of their overall health state. OBJECTIVES: To evaluate PASS and determine the factors associated with a satisfactory PASS for psoriatic patients. METHODS: Three questions were asked: (Q1) Considering the ways that your skin symptoms affect your functioning, is your current skin psoriasis satisfactory? (Current PASS), (Q2) Considering the ways that your psoriasis is affecting you, if you were to remain in this state for the next few months, would this be satisfactory? (Future PASS) and (Q3) If you were to remain for the rest of your life as you were during the last 48 hours, would this be satisfactory? (Lifelong PASS). Disease severity, symptoms and health-related quality of life (HRQoL) were collected. RESULTS: Of 140 patients, 74.3%, 70.0% and 85.7% expressed satisfaction with their current, future and lifelong skin psoriasis conditions respectively. A satisfactory PASS was significantly associated with older and married patients; lower disease severity; fewer skin symptoms; and a higher HRQoL. A multivariate analysis revealed that the independent factors associated with a satisfactory PASS were being older than 40 years, being married, practising meditation, not having extensive lesions at sensitive areas and having a high HRQoL. CONCLUSIONS: PASS is a simple and easily administered questionnaire that reflects both disease severity and HRQoL. Understanding patients' needs and satisfaction levels will result in better care for psoriatic patients than otherwise.

Acculturation and use of traditional medicine among African migrant women in Sydney: a mixed method study.

BACKGROUND: More than 80% of the African population depend on traditional medicine as a primary healthcare. Although the African migrant community is increasing in Australia, there is no research documenting if and how African migrant communities have maintained or changed their use of traditional health practices after migration. This study aims to answer the following research questions: does acculturation influence the use of traditional medicine? and how are cultural health practices or beliefs manifested among African migrant women in Australia? METHOD: A mixed methods design which involved a cross-sectional survey (n = 319) and individual interviews (n = 15) was conducted. Survey data were analysed using SPSS (version 23) and logistic regression model was used to test associations. Qualitative data were analysed thematically using NVivo 11 software to identify themes and conceptual categories in the participants' responses. The study was informed by acculturation theory. RESULT: Both the survey and the interview data indicated that cultural health practices were retained as an important form of healthcare for African migrant women in Sydney. The findings indicated that African migrants continued to use traditional medicines as part of their cultural identity and to build cohesive ethnic community to share traditional values and cultural practices. Women who relatively stayed for shorter period of time in Australia and migrated at a later age were more likely to use TM. CONCLUSION: Acculturation proxy measures increased the likelihood of TM use suggesting African migrant women retain their cultural health practices in Australia and use of TM was manifested as part of their cultural identity. The findings have implications to improve the provision of culturally sensitive and responsive health services when caring for African migrant women.

Decolonizing health in Canada: A Manitoba first nation perspective.

INTRODUCTION & BACKGROUND: Global persistence of health inequities for Indigenous peoples is evident in ongoing discrepancies in health and standards of living. International literature suggests the key to transformation lies in Indigenous efforts to control Indigenous health and healthcare. Previous authors have focused upon participation, structural transformation, and culturally appropriate healthcare recognized as a political right as fundamental tenets of Indigenous control. Contextualizing Indigenous health and wellness falls within a growing discussion on decolonization - a resituating of expertise that privileges Indigenous voice and interests. METHODS: The study is a qualitative, grounded theory analysis, which is a constructivist approach to social research allowing for generation of theory in praxis, through interactions and conversations between researchers and participants. One hundred eighty-three interviews with additional focus groups were held between 2013-15 in eight Manitoba First Nation communities representing different models of health delivery, geographies, accessibilities, and Indigenous language groups. Community research assistants and respected Elders participated in data collection, analysis and interpretation. Line-by-line coding and constant comparative method led to the discovery of converging themes. FINDINGS: Ultimately four main themes arose: 1) First Nation control of healthcare; 2) traditional medicine and healing activities; 3) full and meaningful community participation; and 4) cleaning up impacts of colonization. Joint analyses and interpretation of findings revealed substantial evidence that communities were looking profoundly into problems of improperly delivered services and health inequities. Issues were consistent with those highlighted by international commissions on reconciliation, health, Indigenous rights and liberties. To those documents, these findings add ground upon which to build the transformative agenda. RESULTS & DISCUSSION: Communities discussed the need for creation of protocols, constitution and laws to ensure growth of a decolonizing agenda. Inclusive to the concept are holistic, preventative, traditional health perspectives, and Indigenous languages. Colonization impacts were of critical concern and in need of undoing. Sharing of social and political efforts is seen as pivotal to change and includes all members of communities.

Use of complementary and alternative medicine in patients with cancer and their relationship with health behaviours - Cross-sectional study.

INTRODUCTION AND OBJECTIVE: Although the use of complementary and alternative medicine (CAM) is common with Polish cancer patients, little is known about cancer patients' methods of using CAM and how it correlates with their health behaviour. The aim of the study was to determine the scope of application of complementary and alternative medicine methods among patients treated by oncology and to compare the health behaviours of patients who use alternative medicine with those who do not use these methods. MATERIAL AND METHODS: The studies were conducted from August 2019 - January 2020 in an Oncology Centre in south-eastern Poland. A cross-sectional study was conducted in a group of 208 oncological patients. The authors' own questionnaire and the standardized Health Behaviour Inventory were used. RESULTS: Most of the patients (85.09%) declared that they used complementary and alternative medicine methods. 45.19% of the respondents had a high rate of health behaviours. It was observed that there was no communication related to the use of CAM among the patients and healthcare staff. Patients using CAM demonstrated more positive health behaviours than those who were not using these methods (p<0.001). CONCLUSIONS: The majority of the surveyed patients suffering from cancer used complementary and alternative medicine and declared that it was very or slightly effective in strengthening the immune system and helpful in fighting cancer. The patients who used CAM exhibited a higher level of health behaviours than those who did not use these methods.

[The God of the poor: socio-anthropology of resistance to the COVID-19 in Cameroonian cities]. / Le Dieu des pauvres: socio-anthropologie de la résistance des villes Camerounaises à la COVID-19.

INTRODUCTION: since its appearance, the COVID-19 has exhausted global health systems. It was predictable that countries with weak health systems will be severly wiped out by the pandemic. Countries across Europe faced severe human loses and it was foreseable that Africa will experience an even worse tragedy. Suprisingly, since the evolution of the pandemic, there has been remarkable resistance from African countries, including Cameroon. METHOD: the study was phenomenographic. The data were collected successively from media observations (in particular the WHO site, national TV (CRTV) programs 'Parlons COVID'), social networks - Facebook and Whatsapp) and direct observations of some quarters of Garoua (Roumdé-Adjia, Foulbéré, Kakataré) and Mora for the Far North and the southern zone of Yaoundé (Ngoa-Ekelé, Nkolondom, Mokolo). These observations were associated with individual interview, reviews and note-taking around places of public circulation (places of worship, markets and discussion sites (Faada). The theory of functionalism was mobilized in this study. RESULTS: the results show that Cameroonians perceive the pandemic as an eminently metasocial phenomenon which explains their tendency to use prayers, nature to counter this attack. CONCLUSION: the study suggests that a multidimensional approach is capable of offering avenues of « liberation ¼. Also, the study once again raises the place of traditional medecine in health systems and shows the close link that exists between traditional medicine and spirituality.

Perceptions and experiences of a manual therapy trial: a qualitative study of people with moderate to severe COPD.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) presents with physical, emotional and social difficulties that affect quality of life. Multimodal management includes both pharmacological and non-pharmacological strategies, and pulmonary rehabilitation (PR) plays an important role. Recent research has suggested that manual therapies may improve perceptions of dyspnea for people with COPD. METHODS: Focus group interviews were conducted as part of a mixed methods study to assess the feasibility of implementing a manual therapy technique-muscle energy technique (MET)-as an adjunct to PR for people with moderate to severe COPD. Focus group interviews were conducted to examine trial participants views of the intervention and the trial design. A thematic analysis was undertaken to explore the data. RESULTS: Twelve participants with moderate to severe COPD participated in three focus groups. Participants were motivated to participate in the trial to be proactive about their health. They perceived MET to be a gentle, comfortable form of stretching that allowed them to 'breathe easier' and prepared them for PR. A small number of participants reported mild muscular discomfort during MET, but this was short-lasting and was not bothersome. Participants enjoyed the one-on-one contact with researchers and learned more about their breathing while performing spirometric testing. Most participants wanted longer and more frequent MET sessions, and some requested 'homework' stretching exercises. CONCLUSIONS: The findings of this study show that a manual therapy intervention was received well by participants in a clinical trial setting. A small number of participants reported mild musculoskeletal discomfort in relation to the MET treatment. Participant preferences for additional and longer treatment sessions should be carefully considered against available resources in future clinical trials. TRIAL REGISTRATION: ANZCTR, ACTRN12618000801213. Registered 11 May 2018 - Retrospectively registered. http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374643&isReview=true.

Healing myths, yoga styles and social bodies: socio-logics of yoga as a health practice in the socially stratified city of Marseille, France.

Drawing on participant observation and interviews in two yoga studios in the highly socially stratified city of Marseille, France, this paper explores the understandings of yoga as a health practice that emerge at the intersections between yoga styles and their social contexts of consumption. Its insights emerge from the comparison of three modern yoga styles that were developed for Western English-speaking cultural contexts - Iyengar, Bikram and Forrest - and which differ in form but also in the chronology of their emergence on the global yoga market and that of their reception in France. These three yoga styles are also branded through contrasting mythologies of transformational healing, and the aim of this paper is to explore how a brand conceptualization of yoga as a health practice relates to or resonates with the embodied experiences of practitioners, and to the socio-cultural contexts in which practitioners and their practices are embedded. The paper contributes a new case study to the global yoga scholarship and to a poorly studied French yoga scene, but more importantly, it cross-examines the discourses through which a yoga style is branded, the way it is transmitted, and the social context and social positioning of the individuals who practice it. Combining perspectives on the body, narrative and rituals, it identifies how yoga healing is construed in relation to gender, ethnicity and class and the points of consensus and dissent that emerge from the encounters between French social bodies and exogenous yoga styles.

The health imaginary of postural yoga.

This paper explores the capacity of yoga narratives and practices to contribute to and relate ideas about health. It adds theoretically to existing literature on yoga by introducing the concept of the 'health imaginary' as an analytic lens for considering yoga discourses in late modern times, where personal health care and spiritual ambitions are once again becoming blurred. With this perspective, the paper provides a thorough analysis of how yoga postures (asanas) are conceived to work therapeutically, in yoga's recent history and in present-day yoga therapy. Taking case studies from India and Germany, it is shown empirically how the application of asanas is rationalized differently in specific geographical and therapeutic environments - particularly regarding the presumed theory of the body. Thus, the concept of the health imaginary not only provides analytic space to explore the implicit logics and goals of healing in different contexts, but also offers clues about the distinct social, cultural/religious, and local influences that draw people into yoga and contribute to its selective appropriation across the globe.

Raising Children on a Vegan Diet: Parents' Opinion on Problems in Everyday Life.

A growing number of Italian families are adopting a vegan diet (VD) for their offspring from infancy for various reasons, with health benefits and ethics being the most common reasons. Barriers to effective communication with primary care pediatricians (PCPs) are perceived by many parents and, depending on the actors involved and the environment, a VD may affect social interactions in everyday life. A national cross-sectional survey was conducted between July and September 2020. Parents of children following a VD completed an online questionnaire. Data from 176 Italian parents were collected. About 72% (71.8%) of the children included in this study had been on a VD since weaning. Parents did not inform their primary care pediatricians (PCP) about the VD in 36.2% of the cases. In 70.8% of the cases, PCPs were perceived as skeptical or against a VD. About 70% (71.2%) of the parents relied on medical dietitians, and 28.2% on nutritionists/dietitians for dietary counseling. Parents administered an individual B12 supplement in 87.2% of the cases. To the best of our knowledge, this survey is the first which explores the relationship between vegan parents and their PCPs, the parental management of their children's diet and problems regarding the implementation of a VD in everyday life.

Reflection: Spirituality during COVID-19.

In this article, the author describes how spirituality affect the lives of people during COVID-19 pandemic. The author reflects on the meaning of religiosity and spirituality (R/S) from a practical, theological and pastoral point of view. This article presents new insights on the ongoing search for meaning and purpose of life amidst the COVID-19 pandemic.

'I was scared I will end up in another abortion': a mixed-methods study assessing the impact of COVID-19 pandemic and lockdown on the antenatal care of pregnant women in Puducherry, South India.

BACKGROUND: As a mitigation measure for COVID-19 pandemic, lockdown was implemented in India for a period of 2 months (24 March-31 May 2020). Disruption in antenatal care (ANC) provisions during lockdown is expected due to diversion of public health facilities on pandemic. OBJECTIVE: To assess the proportion of pregnant women who had not completed the ideal number of antenatal visits, availability of iron-folic acid (IFA) supplements and challenges in availing health services during the period of lockdown. METHODS: A concurrent mixed-methods study was conducted among pregnant women in Puducherry, India. Information on obstetric characteristics and details regarding antenatal visits were collected through telephonic interviews. In-depth interviews were conducted to understand the perceived challenges in availing health services during the lockdown period. RESULTS: Out of 150 pregnant women, 62 [41.3%; 95% confidence interval (CI) 33.6-49.3] did not complete the ideal number of visits and 61 (40.7%, 95% CI 32.7-49.0) developed health problems. Out of 44 women who received medical care for health problems, 11 (25%) used teleconsultation. Of all the women, 13 (8.7%, 95% CI 4.9-14.0) had not taken the IFA supplements as prescribed by the health provider. Economic hardship, restricted mobility, lack of information about the health system changes and psychological stress due to the fear of COVID were the challenges in accessing care. CONCLUSIONS: Two out of five pregnant women did not complete the ideal number of visits and developed health problems during the lockdown period.

Family attitudes about and experiences with medical cannabis in children with cancer or epilepsy: an exploratory qualitative study.

BACKGROUND: Cannabis is legal for recreational and medical use in Canada. Our aim was to explore family experiences using medical cannabis for children with severe conditions in the context of legalization. METHODS: We conducted a qualitative study using semistructured interviews between April and July 2019. Participants were parents of children attending BC Children's Hospital oncology or palliative care clinics, recruited through posters, emails or referral. Participants were included if they spoke English and their child used any type of cannabis for medical purposes. Interviews included open-ended questions about the child's cannabis use. Interviews were recorded and transcribed, and thematic analysis was performed using qualitative description. RESULTS: Ten interviews were completed with 9 mothers and 1 mother-father pair. The age range of the children was 22 months to 16 years. The primary reasons for cannabis use were epilepsy (6 children) or chemotherapy management (4 children). Five major themes were identified. 1) Child and family context, and cannabis as a last resort: children were seen as severely ill; parents sought cannabis out of desperation and responsibility to their child. 2) Varied information sources informed decision-making: parents lacked resources from health care providers and sought support from social media, industry and other families. 3) Cannabis as an ambiguous medicine: cannabis was viewed as both a serious drug that doctors should prescribe and as a natural alternative health product, safe to pursue alone. 4) Perceived effects: parents perceived medical benefits with few concerns about adverse effects. 5) Legal and financial challenges: parents were willing to obtain cannabis despite high costs and uncertain legality. INTERPRETATION: Parents of children with severe conditions pursued medical cannabis despite obstacles and needed unbiased information to access alone. Scientific investigation is needed to develop pediatric medical guidelines to inform decisions.

Retrospective Evaluation of Hepatitis C Awareness in Turkey Through Two Decades.

BACKGROUND/AIMS: Chronic hepatitis C (CHC) is the only viral infection that can be treated with oral antiviral agents. However, CHC awareness is a major barrier to the World Health Organization's target of eliminating hepatitis C virus (HCV) by 2030. Here, CHC awareness trends were analyzed in Hacettepe University Hospital, Turkey, between January 2000 and December 2017. MATERIALS AND METHODS: Central laboratory data were retrospectively analyzed for HCV test results (anti-HCV, HCV RNA, HCV genotype). After combining 548,141 anti-HCV test results, 395,103 cases were analyzed. The following two parameters were defined for CHC awareness: (1) the presence of HCV RNA results for anti-HCV positives and (2) the presence of a genotype result for HCV RNA positives. RESULTS: Anti-HCV positives were older than negatives (mean age-years ± SD, 59.4 ± 19.0 vs. 44.0 ± 18.9), and the positivity rate was higher in women than in men (1.4% vs. 1.0%). Anti-HCV positivity decreased from 3.1% to 0.6% from 2000 to 2015 and subsequently stabilized. The overall percentage of RNA testing among anti-HCV positives was 53.1% (range, 20%-70%), which stabilized at approximately 50% after 2010. The genotyping rate for RNA positives varied between 40% and 70%. The main genotype identified was genotype 1 (85.7%). CONCLUSION: In an ideal CHC awareness state, all anti-HCV positives should undergo RNA testing, and genotyping should be performed when RNA tests are positive. However, even in our referral center, the combined rate of RNA and genotype testing was only approximately 50% during the last 10 years.

Psychological assessment and lived experiences of recovered COVID-19 patients who presented for convalescent plasma donation.

BACKGROUND: Increasingly, it has been seen that patients recovering from COVID-19 may face a second battle of coping with its mental health ramifications. These psychological issues can even be experienced by patients who were asymptomatic or had mild to moderate symptoms, potentially impacting their quality of life. METHODOLOGY: This was a prospective observational study to analyse the psychological impact of COVID-19 in recovered patients who presented as prospective convalescent plasma (CP) donors. An interview for the psychological assessment of the prospective donors was carried out. Depression and anxiety in the participants were assessed by HAM-A, and HAM-D scores and Quality of Life were assessed using the WHOQOL-BREF scale. RESULTS: A total of 51 prospective donors were assessed, with a mean age of 34.37 (±9.08) years, with the majority being males (46). No clinically significant depression and anxiety were found on the basis of HAM-D and HAM-A scores. The worst affected quality of life parameter, based on the WHOQOL-BREF scale, was physical quality of life followed by environmental, psychological, and social relationships. Moreover, due to infection, social stigma was experienced by 49.02% of the donors, while 21.97% had anxiety related to convalescent plasma donation as a common livid experience. CONCLUSION: Poor quality of life and social stigma during the recovery phase is prevalent in COVID-19 recovered patients, for which formulation of holistic support strategies are the need of the hour.

Investigating patients´ views on screening for depression in cardiac practice: A qualitative interview study.

OBJECTIVE: Recommendations on screening for depression in patients with coronary heart disease (CHD) are highly debated. While recent research has prioritized efficacy studies, little is known about what is potentially required for screening to be efficacious. Expanding our knowledge of how patients with CHD view screening is likely to pose a first step towards addressing this gap. We aimed to investigate patients ́ views on routine screening for depression in cardiac practice. METHODS: This exploratory, qualitative study was conducted among 12 patients with CHD, who completed semi-structured interviews. We used a purposive sampling strategy to include patients within a range of ages, gender and self-reported depression. Thematic analysis was carried out. RESULTS: We identified four main themes: Acceptance, utility, barriers and expectations. Patients in this sample appeared to be in favor of standardized routine screening for depression in cardiac practice, if the rationale was disclosed. Patients reported that standardized screening addresses holistic care demands, promotes validation of individual symptom burden and legitimizes the display of psychological distress in cardiac practice. Yet, skepticism towards the validity of screening instruments and perceived stigmatization could pose a main barrier to screening efficacy. Patients expected to receive feedback on results and consecutive recommendations. CONCLUSION: We found that depression screening is endorsed by patients with CHD in this study sample. Standardized routine screening procedures could serve as a useful tool to combat stigmatization, and encourage patients to display symptoms of depression towards cardiologists. The efficacy of depression screening could potentially be enhanced by tailoring the screening process towards patients´ needs.

Is it safe yet? Patient readiness and perceptions about returning to hospital for planned orthopaedic care.

INTRODUCTION: COVID-19 has necessitated significant changes to healthcare delivery but little is known regarding patient opinions of risks compared with benefits. This study investigates patient perceptions concerning attendance for planned orthopaedic surgery during the COVID-19 pandemic. MATERIALS AND METHODS: A total of 250 adult patients from the elective orthopaedic waiting list at Cardiff and Vale University Health Board were telephoned during lockdown. They were risk stratified for COVID-19 based on British Orthopaedic Association guidance and a discussion was held to determine patient willingness to proceed with surgery. The primary outcome measure was patients' willingness to proceed. RESULTS: Of the total number telephoned, 196 patients were included in the study, with a mean age of 57.4 years; 129 patients were willing to attend for surgery, leaving over one-third wishing to cancel or defer. The most frequent reason given for not wishing to attend was fear of contracting COVID-19. There was a statistically significant difference in the willingness to proceed observed with increasing clinical risk (χ2(3) = 50.073, p = .000) with almost double the expected count of unwilling to proceed in the high and very high risk groups, equalled by half the expected count in the low risk group. DISCUSSION: This study illustrates the variable and personal decisions that patients are making about orthopaedic care because of COVID-19. It highlights the need for change to departmental processes regarding recommencement of planned surgical lists. It also reconfirms the importance of regular communication and shared decision making between a well-informed patient and a holistic orthopaedic team.

Experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia: A five-cohort cross-sectional comparison.

INTRODUCTION: The global COVID-19 pandemic has radically changed the way health care is delivered in many countries around the world. Evidence on the experience of those receiving or providing maternity care is important to guide practice through this challenging time. METHODS: A cross-sectional study was conducted in Australia. Five key stakeholder cohorts were included to explore and compare the experiences of those receiving or providing care during the COVID-19 pandemic. Women, their partners, midwives, medical practitioners and midwifery students who had received or provided maternity care from March 2020 onwards in Australia were recruited via social media and invited to participate in an online survey released between 13th May and 24th June 2020; a total of 3701 completed responses were received. FINDINGS: While anxiety related to COVID-19 was high among all five cohorts, there were statistically significant differences between the responses from each cohort for most survey items. Women were more likely to indicate concern about their own and family's health and safety in relation to COVID-19 whereas midwives, doctors and midwifery students were more likely to be concerned about occupational exposure to COVID-19 through working in a health setting than those receiving care through attending these environments. Midwifery students and women's partners were more likely to respond that they felt isolated because of the changes to the way care was provided. Despite concerns about care received or provided not meeting expectations, most respondents were satisfied with the quality of care provided, although midwives and midwifery students were less likely to agree. CONCLUSION: This paper provides a unique exploration and comparison of experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia. Findings are useful to support further service changes and future service redesign. New evidence provided offers unique insight into key stakeholders' experiences of the rapid changes to health services.