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1.
Rural Remote Health ; 22(1): 7050, 2022 02.
Article in English | MEDLINE | ID: mdl-35119906

ABSTRACT

INTRODUCTION: Past studies examined factors associated with rural practice, but none employed newer machine learning (ML) methods to explore potential predictors. The primary aim of this study was to identify factors related to practice in a rural area. Secondary aims were to capture a more precise understanding of the demographic characteristics of the healthcare professions workforce in Utah (USA) and to assess the viability of ML as a predictive tool. METHODS: This study incorporated four datasets - the 2017 dental workforce, the 2016 physician workforce, the 2014 nursing workforce and the 2017 pharmacy workforce - collected by the Utah Medical Education Council. Supervised ML techniques were used to identify factors associated with practice location, the outcome variable of interest. RESULTS: The study sample consisted of 11 259 healthcare professionals with an average age of 46.6 years, of which 36.6% were males and 94.5% Caucasian. Four ML methods were applied to assess model performance by comparing accuracy, sensitivity, specificity and area under the receiver operating characteristic (ROC) curve. Of the methods used, support vector machine performed the best (accuracy 99.7%, precision 100%, sensitivity 100%, specificity 99.4% and ROC 0.997). The models identified income and rural upbringing as the top factors associated with rural practice. CONCLUSION: By far, income emerged as the most important factor associated with rural practice, suggesting that attractive income offers might help rural communities address health professional shortages. Rural upbringing was the next most important predictive factor, validating and updating earlier research. The performance of the ML algorithms suggests their usefulness as a tool to model other databases for individualized prediction.


Subject(s)
Rural Health Services , Delivery of Health Care , Health Personnel , Humans , Machine Learning , Male , Middle Aged , Professional Practice Location , Workforce
2.
Article in Spanish | PAHO-IRIS | ID: phr-56068

ABSTRACT

[RESUMEN]. Se presenta el posicionamiento del grupo de trabajo latinoamericano de la Fundación Internacional para los Cuidados Integrados (1) (IFIC, por su sigla en inglés). Este reúne a diversos actores y organizaciones de América Latina, con el objeto de apoyar acciones que faciliten la transformación de los sistemas de salud en la Región hacia sistemas integrados y centrados en las personas, no como individuos aislados, sino como sujetos de derecho, en los contextos sociales y ambientales complejos donde viven y se vinculan. El grupo de trabajo plantea nueve pilares de la atención integrada para ser utilizados como marco conceptual en la elaboración de políticas y de cambios en las prácticas: 1) visión y valores compartidos, 2) salud de las poblaciones, 3) las personas y las comunidades como socias, 4) comunidades resilientes, 5) capacidades del talento humano en salud, 6) gobernanza y liderazgo, 7) soluciones digitales, 8) sistemas de pago alineados, y 9) transparencia ante la ciudadanía. Desde estos pilares se proponen líneas de trabajo en los ámbitos del fortalecimiento de alianzas y redes, la abogacía, la investigación y generación de capacidades, que contribuyan a materializar sistemas de salud y sociales efectivamente integrados y centrados no solo en las personas, sino también en las comunidades en América Latina.


[ABSTRACT]. This paper presents the position of the Latin American working group of the International Foundation for Integrated Care (IFIC). The working group brings together various Latin American actors and organizations in support of actions that facilitate the transformation of health systems in the region towards integrated systems that focus on people not as isolated individuals but as subjects of law in the complex social and environmental contexts where they live and interact. The working group proposes nine pillars of integrated care to be used as a conceptual framework for policy development and changes in practices: 1) shared vision and values; 2) population health; 3) people and communities as partners; 4) resilient communities; 5) capacities of human resources for health; 6) governance and leadership; 7) digital solutions; 8) aligned payment systems; and 9) public transparency. Based on these pillars, lines of work are proposed to strengthen alliances and networks, advocacy, research, and capacity-building, in order to help develop health and social systems that are effectively integrated and focused not only on people but also on communities in Latin America.


[RESUMO]. Este artigo apresenta o posicionamento do grupo de trabalho latino-americano da Fundação Internacional de Cuidados Integrados (1) (IFIC, na sigla em inglês). A IFIC reúne diversos atores e organizações da América Latina com o fim de apoiar ações que facilitem a transformação dos sistemas de saúde na região para sistemas integrados e centrados nas pessoas, não como indivíduos isolados, mas como sujeitos de direito, nos complexos contextos sociais e ambientais em que vivem e participam. O grupo de trabalho propõe nove pilares de atenção integrada a serem utilizados como marco conceitual na elaboração de políticas e de mudanças nas práticas: 1) visão e valores compartilhados, 2) saúde das populações, 3) pessoas e comunidades como parceiros, 4) comunidades resilientes, 5) capacitação de talento humano em saúde, 6) governança e liderança, 7) soluções digitais, 8) sistemas de pagamento alinhados e 9) transparência perante a população. Com base nesses pilares, são propostas linhas de trabalho nas áreas de fortalecimento de alianças e redes, incidência política, pesquisa e capacitação, que contribuam para materializar na América Latina sistemas sociais e de saúde efetivamente integrados e centrados não só nas pessoas, como também nas comunidades.


Subject(s)
Delivery of Health Care , Health Policy , Health Care Reform , Health Policy, Planning and Management , Primary Health Care , Delivery of Health Care , Health Policy , Health Care Reform , Health Policy, Planning and Management , Primary Health Care , Delivery of Health Care , Health Policy , Health Care Reform , Health Policy, Planning and Management , Primary Health Care
3.
BMC Med Educ ; 22(1): 427, 2022 Jun 02.
Article in English | MEDLINE | ID: mdl-35655298

ABSTRACT

BACKGROUND: Medical education has been criticised for not adapting to changes in society, health care and technology. Internationally, it is necessary to strengthen primary health care services to accommodate the growing number of patients. In Norway, emergency care patients are increasingly treated in municipal emergency care units in the primary health care system. This study explores medical students' learning experience and how they participated in communities of practice at two municipal emergency care units in the primary health care system. METHODS: In this qualitative study, we collected data from March to May 2019 using semi-structured individual interviews and systematic observations of six ninth-semester medical students undergoing two-week clerkships at municipal emergency care units. The interview transcripts were thematically analysed with a social constructivist approach. A total of 102 systematic observations were used to triangulate the findings from the thematic analysis. RESULTS: Three themes illuminated what the medical students learned and how they participated in communities of practice: (i) They took responsibility for emergency care patients while participating in the physicians' community of practice and thus received intensive training in the role of a physician. (ii) They learned the physician's role in interprofessional collaboration. Collaborating with nursing students and nurses led to training in clinical procedures and insight into the nurses' role, work tasks, and community of practice. (iii) They gained in-depth knowledge through shared reflections when time was allocated for that purpose. Ethical and medical topics were elucidated from an interprofessional perspective when nursing students, nurses, and physicians participated. CONCLUSIONS: Our findings suggest that this was a form of clerkship in which medical students learned the physician's role by taking responsibility for emergency care patients and participating in multiple work tasks and clinical procedures associated with physicians' and nurses' communities of practice. Participating in an interprofessional community of practice for professional reflections contributed to in-depth knowledge of ethical and medical topics from the medical and nursing perspectives.


Subject(s)
Education, Medical , Students, Medical , Delivery of Health Care , Emergency Service, Hospital , Humans , Qualitative Research
4.
Pan Afr Med J ; 41: 181, 2022.
Article in English | MEDLINE | ID: mdl-35655688

ABSTRACT

Introduction: overtime, tuberculosis (TB) has remained the most common opportunistic infection among people living with HIV (PLHIV). Proper implementation of TB infection control (TBIC) practices in health care facilities can curb TB menace among PLHIV and the public. We assessed the implementation of TB infection control in health care facilities offering Anti-Retroviral Therapy (ART) in Enugu State, Nigeria. Methods: we employed a cross-sectional research design and assessed TB infection control practices in nine State owned public health care facilities offering antiretroviral therapy (ART) services for PLHIV. A 23 item World Health Organization (WHO) checklist for infection control in health care facilities was used to collect data. We assessed the five minimum standards as well as the four sets of TB infection control (TBIC) measures. Frequencies, percentages and chi square statistic were used to analyze data. Results: only four (44%) health care facilities that provides ART services studied in Enugu State implemented TBIC practices. Higher proportion of the rural and secondary facilities implemented TBIC although the difference is not statistically significant (p>0.05). Implementation was better with the administrative controls while the personal protective equipment was almost non-existent. Conclusion: less than half of the facilities offering ART services in the Enugu State have TB infection control measures. We therefore recommend that in order to reduce TB infection among PLHIV, the issue of proper TBIC in health care facilities need urgent attention. Materials provision, staff training and retraining are issues that must be tackled to achieve the aim of reduction of TB infection among PLHIV, health care workers and the public.


Subject(s)
HIV Infections , Latent Tuberculosis , Tuberculosis , Cross-Sectional Studies , Delivery of Health Care , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Infection Control , Nigeria , Tuberculosis/drug therapy , Tuberculosis/epidemiology , Tuberculosis/prevention & control
5.
J Healthc Eng ; 2022: 2170839, 2022.
Article in English | MEDLINE | ID: mdl-35655717

ABSTRACT

Several studies aimed at improving healthcare management have shown that the importance of healthcare has grown in recent years. In the healthcare industry, effective decision-making requires multicriteria group decision-making. Simultaneously, big data analytics could be used to help with disease detection and healthcare delivery. Only a few previous studies on large-scale group decision-making (LSDGM) in the big data-driven healthcare Industry 4.0 have focused on this topic. The goal of this work is to improve healthcare management decision-making by developing a new MapReduce-based LSDGM model (MR-LSDGM) for the healthcare Industry 4.0 context. Clustering decision-makers (DM), modelling DM preferences, and classification are the three stages of the MR-LSDGM technique. Furthermore, the DMs are subdivided using a novel biogeography-based optimization (BBO) technique combined with fuzzy C-means (FCM). The subgroup preferences are then modelled using the two-tuple fuzzy linguistic representation (2TFLR) technique. The final classification method also includes a feature extractor based on long short-term memory (LSTM) and a classifier based on an ideal extreme learning machine (ELM). MapReduce is a data management platform used to handle massive amounts of data. A thorough set of experimental analyses is carried out, and the results are analysed using a variety of metrics.


Subject(s)
Delivery of Health Care , Health Facilities , Big Data , Data Science , Decision Making , Humans
7.
Front Public Health ; 10: 832090, 2022.
Article in English | MEDLINE | ID: mdl-35664122

ABSTRACT

Background: Switzerland has a universal healthcare system. Yet, undocumented migrants face barriers at different levels that hinder their access to healthcare services. The aim of this study is to assess whether undocumented migrants' healthcare utilization improves with residence status regularization. Methods: We used two-wave panel data from the Parchemins study, a study exploring the impact of regularization on undocumented migrants' health in Geneva, Switzerland. First wave data were collected between 2017 and 2018, second wave data between 2019 and 2020. At baseline, the sample consisted of 309 undocumented migrants, recruited after the implementation of a temporary regularization policy in Geneva. We distributed them into two groups according to their residence status 12 months before the second data collection [regularized vs. undocumented (controls)]. Using as dependent variable the number of medical consultations within two distinct 12-months periods (the first before regularization, the second after regularization), we conducted multivariable regression analyses applying hurdle specification to identify factors enhancing healthcare utilization. Then, we estimated first-difference panel models to assess change in healthcare utilization along regularization. Models were adjusted for demographic, economic and health-related factors. Results: Of the 309 participants, 68 (22%) were regularized. For the 12 months before regularization, these migrants did not significantly differ in their healthcare utilization from the controls. At this stage, factors increasing the odds of having consulted at least once included being a female (aOR: 2.70; 95% CI: 1.37-5.30) and having access to a general practitioner (aOR: 3.15; 95% CI: 1.62-6.13). The factors associated with the number of consultations apart from underlying health conditions were the equivalent disposable income (aIRR per additional CHF 100.-: 0.98; 95% CI: 0.97-1.00) and having access to a general practitioner (aIRR: 1.45; 95% CI: 1.09-1.92). For the 12 months after regularization, being regularized was not associated with higher odds of having consulted at least once. However, among participants who consulted at least once, regularized ones reported higher counts of medical consultations than controls (3.7 vs. 2.6, p = 0.02), suggesting a positive impact of regularization. Results from the first-difference panel models confirmed that residence status regularization might have driven migrants' healthcare utilization (aß: 0.90; 95% CI: 0.31-1.77). Conclusions: This study supports the hypothesis that residence status regularization is associated with improved healthcare utilization among undocumented migrants. Future research is needed to understand the mechanisms through which regularization improves undocumented migrants' use of healthcare services.


Subject(s)
Transients and Migrants , Delivery of Health Care , Female , Humans , Patient Acceptance of Health Care , Switzerland/epidemiology
8.
Med J Aust ; 216 Suppl 10: S19-S21, 2022 Jun 06.
Article in English | MEDLINE | ID: mdl-35665933

ABSTRACT

Australia's primary health care system works well for most Australians, but 20% of people live with multimorbidity, often receiving fragmented care in a complex system. Australia's 10-year plan for primary health care recognises that person-centred care is essential to securing universal health coverage, improving health outcomes and achieving an integrated sustainable health system. The Health Care Homes trial tested a new model of person-centred care for people with chronic and complex health conditions. This model demonstrated that change can be achieved with dedicated transformational support and highlighted the importance of enablers and reform streams that are now established in the 10-year plan.


Subject(s)
Delivery of Health Care , Multimorbidity , Australia , Health Facilities , Humans
9.
Med J Aust ; 216 Suppl 10: S9-S13, 2022 Jun 06.
Article in English | MEDLINE | ID: mdl-35665934

ABSTRACT

Value co-creation focuses on creating value with and for multiple stakeholders - through purposeful engagement, facilitated processes and enriched experiences - to co-design new products and services. User-centred design enables multidisciplinary teams to design and develop or adapt resources from the end user's perspective. Combining value co-creation and user-centred design offers an effective, efficient, user-friendly and satisfying experience for all participants, and can result in co-created, tailored and fit-for-purpose resources. These resources are more likely to be adopted, be usable, be sustainable and produce outcomes that matter, and thereby create value for all parties. Over the past 6 years, the Education and Innovation Department at Australian General Practice Accreditation Limited has used these methods to co-create education and training programs to build workforce capacity and support implementation of many person-centred integrated care programs. In this article, we present examples of how Australian General Practice Accreditation Limited used value co-creation and user-centred design to develop and deliver education programs in primary health care, and offer insights into how program developers can use these methods to co-create any health care product, service or resource to better address end user needs and preferences. As we strive to strengthen the role of consumers as active partners in care and improve service delivery, patient outcomes and patient experiences in Australia, it is timely to explore how we can use value co-creation and user-centred design at all levels of the system to jointly create better value for all stakeholders.


Subject(s)
Delivery of Health Care , Health Facilities , Australia , Humans , Workforce
10.
Med J Aust ; 216 Suppl 10: S3-S4, 2022 Jun 06.
Article in English | MEDLINE | ID: mdl-35665938

ABSTRACT

In this article we ask: to what extent is person-centred care truly embedded in our system, and are we making the most of the policy levers that could help? We describe person-centred care, shine a light on deficits in the health system, and point to some policy enablers to support person-centred care. Cultural change and a commitment to value-based health care are required. We highlight the merit in adopting and acting on patient-reported measures as an indicator of what matters to the patient, the need for integrated data systems, and the role of a co-creation approach. Most importantly, we underscore the importance of funding reform and consumer leadership.


Subject(s)
Delivery of Health Care , Patient-Centered Care , Health Facilities , Humans , Leadership , Self Care
11.
Med J Aust ; 216 Suppl 10: S24-S27, 2022 Jun 06.
Article in English | MEDLINE | ID: mdl-35665939

ABSTRACT

In this article, we discuss how the value-based health care concept has matured across recent years, and consider how it can be achieved in the primary health care sector. We provide illustrations of related initiatives across the four domains of value-based health care, highlight the need for cultural transformation and reorientation of the system, and call for a national framework and agreed plan of action.


Subject(s)
Delivery of Health Care , Primary Health Care , Australia , Humans
12.
Health Syst Reform ; 8(1): e2064792, 2022 Jan 01.
Article in English | MEDLINE | ID: mdl-35666262

ABSTRACT

This paper determines the effect of international remittances on the healthcare utilization of childbearing mothers in Pakistan using the Pakistan Social and Living Standards Measurement (PSLM) survey, 2018-19. The study reports a significant and positive effect of international remittances on the healthcare outcomes of childbearing mothers. Importantly, the remittance-receiving households have 0.615, 0.208 and 0.306 times the odds of the non-receiving households, utilizing prenatal healthcare, postnatal healthcare, and healthcare decision making, respectively, and all of them are statistically significant. Consequently, the analysis confirms that remittance receiving-households do in fact influence and increase the likelihood of utilizing prenatal healthcare, postnatal healthcare and decisions about medical treatment for women. As regression-based estimation of remittances is prone to selection bias due to the nature of the non-experimental data set, we also used propensity score matching methods, which also confirmed a significant and positive effect of international remittances on healthcare outcomes of the childbearing mothers. Thus, financial support or social development programs by the government or non-governmental organization are pivotal in enhancing the healthcare outcomes and ultimately the living standards of childbearing mothers.


Subject(s)
Patient Acceptance of Health Care , Reproductive Health , Delivery of Health Care , Female , Humans , Pakistan , Pregnancy , Socioeconomic Factors
13.
JAMA Netw Open ; 5(6): e2215418, 2022 Jun 01.
Article in English | MEDLINE | ID: mdl-35666502

ABSTRACT

Importance: Rates of prenatal cannabis use are increasing alongside perceptions that cannabis is a harmless therapeutic for pregnancy-related ailments, while rates of prenatal use of alcohol and tobacco are decreasing. It is important to examine whether cannabis use during pregnancy is increasing similarly among patients with and patients without co-occurring substance use. Objectives: To examine trends in cannabis polysubstance use during pregnancy and to test differences in cannabis use over time among pregnant individuals who use only cannabis vs those who use cannabis and other substances. Design, Setting, and Participants: This cross-sectional time-series study used data from 367 138 pregnancies among 281 590 unique pregnant patients universally screened for prenatal substance use as part of standard care in Kaiser Permanente Northern California from January 1, 2009, to December 31, 2018. Statistical analysis was performed from October 5, 2021, to April 18, 2022. Exposures: Time (calendar year). Main Outcomes and Measures: Use of substances during early pregnancy was assessed via universal screening with a self-administered questionnaire (for cannabis, alcohol, stimulants, and nicotine) and/or positive results of a urine toxicology test (for cannabis, alcohol, stimulants, and pharmaceutical opioids), and data were extracted from the electronic health record. Results: The study sample of 367 138 pregnancies from 281 590 unique pregnant patients (median gestation at time of screening, 8.6 weeks [IQR, 7.3-10.6 weeks]) was 25.9% Asian or Pacific Islander, 6.6% Black, 25.8% Hispanic, 38.0% non-Hispanic White, and 3.6% other race or ethnicity; 1.1% were aged 11 to 17 years, 14.9% were aged 18 to 24 years, 61.9% were aged 25 to 34 years, and 22.1% were aged 35 years or older; and the median neighborhood household income was $70 455 (IQR, $51 563-$92 625). From 2009 to 2018, adjusted rates of use of only cannabis during pregnancy (no other substances) increased substantially from 2.39% (95% CI, 2.20%-2.58%) in 2009 to 6.30% (95% CI, 6.00%-6.60%) in 2018, increasing at an annual relative rate of 1.11 (95% CI, 1.10-1.12). The rate of use of cannabis and 1 other substance also increased (annual relative rate, 1.04 [95% CI, 1.03-1.05]), but not as rapidly (P < .001 for difference), while the rate of use of cannabis and 2 or more other substances decreased slightly (annual relative rate, 0.97 [95% CI, 0.96-0.99]). Adjusted rates of prenatal use of cannabis and alcohol (1.04 [95% CI, 1.03-1.06]) and cannabis and stimulants (1.03 [95% CI, 1.01-1.06]) increased over time, while rates of prenatal use of cannabis and nicotine (0.97 [95% CI, 0.96-0.98]) decreased. Conclusions and Relevance: In this cross-sectional time-series study, rates of prenatal cannabis use during early pregnancy increased significantly more rapidly among patients without co-occurring substance use, which could reflect increased acceptability of cannabis and decreased perceptions of cannabis-related harms. Furthermore, increased rates of use of cannabis with alcohol and stimulants warrant continued monitoring.


Subject(s)
Cannabis , Hallucinogens , Substance-Related Disorders , Analgesics , Cannabinoid Receptor Agonists , Cross-Sectional Studies , Delivery of Health Care , Ethanol , Female , Humans , Nicotine , Pregnancy , Substance-Related Disorders/epidemiology
14.
15.
Rev Esc Enferm USP ; 56: e20210597, 2022.
Article in English | MEDLINE | ID: mdl-35666983

ABSTRACT

OBJECTIVE: To identify elements of the Strengths-Based Nursing and Healthcare in the maternity nurses care practice in a perspective of continuity of care. METHOD: Qualitative exploratory-descriptive study. A focus group was used for data collection, seven meetings were held with 18 nurses between August 2019 and January 2020, starting from a priori categories: "problem-based nursing care" and "strengths-based nursing and healthcare". RESULTS: In the first category, nurses' care is centered on problems identified in women; they keep a hierarchical relationship and a prescriptive posture based on a biomedical model. In the second category, care is focused on singularity, empowerment, self-determination, learning, collaborative partnership, and promotion of women's health, based on a holistic nursing model. CONCLUSION: Although nurses use the biomedical model in their care practice, many of them already use the framework elements empirically. Applying this theoretical framework allows nurses to shift the focus of their attention from the disease to the person/family, promoting health and the continuity of care in a holistic way.


Subject(s)
Delivery of Health Care , Personal Autonomy , Continuity of Patient Care , Female , Focus Groups , Humans , Pregnancy , Qualitative Research
16.
BMJ Open ; 12(6): e057658, 2022 Jun 15.
Article in English | MEDLINE | ID: mdl-35705340

ABSTRACT

OBJECTIVE: Non-invasive prenatal testing (NIPT) is a front-line screening for fatal chromosomal aneuploidy. In pregnant women with a risk of having fetal congenital disorders, NIPT is anticipated to reduce the needs of invasive prenatal diagnostic test (IPD). The objective of this study was to understand the acceptance of NIPT and the utility of NIPT to mitigate concerns about IPD in the US high-risk pregnancy management. DESIGN AND SETTING: This was a retrospective observational research using healthcare records obtained from an academic healthcare system in the US. The study consisted of site-level longitudinal analysis and patient-level cross-sectional analysis. PARTICIPANT: A total of 5660 new high-risk pregnancies with age ≥35 years were identified for the longitudinal trend analysis. Cross-sectional utility assessment included 2057 pregnant women. EXPOSURE AND OUTCOME MEASURES: Longitudinal trends of NIPT order, IPD procedure and the number of patients diagnosed with high-risk pregnancy were descriptively summarised. In the cross-sectional assessment, we tested the association between the use of NIPT and IPD using multivariable regression. RESULTS: The rate of increase in the NIPT use exceeded the changes in the number of high-risk pregnancies with age ≥35 years, while the number of annual IPD procedures has fluctuated without specific trends. There was no significant association between the numbers of NIPT and IPD with the adjusted ORs between 0.90 and 1.14 (p>0.1). The order of NIPT was not selected as an independent variable predicting the use of IPD. Clinical characteristics indicating low socioeconomic status and limited healthcare coverage are associated with less use of NIPT and lower clinical utility. CONCLUSION: Although prenatal care accepted NIPT over the last decade, the utility of NIPT in mitigating concerns on IPD is unclear and needs further investigation. Limited clinical utility should be addressed in the context of disparity in prenatal care.


Subject(s)
Aneuploidy , Prenatal Diagnosis , Adult , Cross-Sectional Studies , Delivery of Health Care , Female , Humans , Pregnancy , Prenatal Diagnosis/adverse effects , Prenatal Diagnosis/methods , Retrospective Studies
17.
BMJ Open ; 12(6): e059526, 2022 Jun 15.
Article in English | MEDLINE | ID: mdl-35705342

ABSTRACT

OBJECTIVES: Incentives have been effectively used in several healthcare contexts. This systematic review aimed to ascertain whether incentives can improve antipsychotic adherence, what ethical and practical issues arise and whether existing evidence resolves these issues. DESIGN: Systematic review of MEDLINE, EMBASE and PsycINFO. Searches on 13 January 2021 (no start date) found papers on incentives for antipsychotics. Randomised controlled trials (RCTs), cohort studies, qualitative research and ethical analyses were included. Papers measuring impact on adherence were synthesised, then a typology of ethical and policy issues was compiled, finally the empirical literature was compared with this typology to describe current evidence and identify remaining research questions. RESULTS: 26 papers were included. 2 RCTs used contingent financial incentives for long-acting injectable antipsychotic preparations. Over 12 months, there were significantly larger increases in adherence among the intervention groups versus control groups in both RCTs. There were no consistently positive secondary outcomes. 39 ethical and practical issues were identified. 12 of these are amenable to empirical study but have not been researched and for 7 the current evidence is mixed. CONCLUSIONS: In keeping with other areas of healthcare, antipsychotic adherence can be increased with financial incentives. Payments of 2.5 times minimum wage changed behaviour. The typology of issues reported in this systematic review provides a template for future policy and ethical analysis. The persistence of the effect and the impact of incentives on intrinsic motivation require further research. PROSPERO REGISTRATION NUMBER: CRD42020222702.


Subject(s)
Antipsychotic Agents , Mental Disorders , Psychotic Disorders , Antipsychotic Agents/therapeutic use , Delivery of Health Care , Humans , Mental Disorders/drug therapy , Motivation , Psychotic Disorders/drug therapy
18.
Rev Bras Enferm ; 75Suppl 2(Suppl 2): e20210872, 2022.
Article in English, Portuguese | MEDLINE | ID: mdl-35674538

ABSTRACT

OBJECTIVES: to present an overview of migratory processes and access to health care for immigrants in Brazil and reflect on the importance of training in Nursing from an interdisciplinary perspective, focused on the care of this population in the context of a pandemic. METHODS: this is a theoretical-reflective study based on the authors' experiences and anchored in the literature. RESULTS: some particularities in the access to health services by migrants and refugees show how the pandemic's advancement and continuity impacted them in different ways. Interdisciplinary research and teaching are essential to study and better understand the health needs of the migrant population in Brazil, especially in the context of a pandemic. FINAL CONSIDERATIONS: the training of health professionals, especially in Nursing, must include these people's specificities so that future interventions are more sensitive and closer to their reality.


Subject(s)
COVID-19 , Emigrants and Immigrants , Refugees , Transients and Migrants , Delivery of Health Care , Humans
19.
Obstet Gynecol ; 139(6): 1201, 2022 Jun 01.
Article in English | MEDLINE | ID: mdl-35675626

ABSTRACT

ABSTRACT: Lower gastrointestinal (GI) diseases and associated symptoms account for a large number of health care visits each year. Many women visit their obstetrician-gynecologists more often than their primary care physicians or use them as primary health care providers. Many gynecologic and lower GI disorders share symptoms, such as lower abdominal or pelvic pain and bloating. Some diseases are more common in women compared with men, such as irritable bowel syndrome (IBS), or warrant special consideration in women, for example, for inflammatory bowel disease (IBD). This monograph outlines the major diseases that affect the lower GI tract and reviews epidemiology, pathology, presentation, and treatment of these diseases. Concerns specific to women are addressed, including reproductive issues, changes in GI physiology during pregnancy, and management of lower GI disease during pregnancy.


Subject(s)
Gastrointestinal Diseases , Irritable Bowel Syndrome , Chronic Disease , Delivery of Health Care , Female , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/prevention & control , Humans , Irritable Bowel Syndrome/diagnosis , Irritable Bowel Syndrome/therapy , Male , Pregnancy , Women's Health
20.
Article in English | MEDLINE | ID: mdl-35682010

ABSTRACT

Financial counselling and income-maximisation services have the potential to reduce financial hardship and its associated burdens on health and wellbeing in High Income Countries. However, referrals to financial counselling services are not systematically integrated into existing health service platforms, thus limiting our ability to identify and link families who might be experiencing financial hardship. Review evidence on this is scarce. The purpose of this study is to review "healthcare-income maximisation" models of care in high-income countries for families of children aged between 0 and 5 years experiencing financial difficulties, and their impacts on family finances and the health and wellbeing of parent(s)/caregiver(s) or children. A systematic review of the MEDLINE, EMBase, PsycInfo, CINAHL, ProQuest, Family & Society Studies Worldwide, Cochrane Library, and Informit Online databases was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) statement. A total of six studies (five unique samples) met inclusion criteria, which reported a total of 11,603 families exposed to a healthcare-income maximisation model. An average annual gain per person of £1661 and £1919 was reported in two studies reporting one Scottish before-after study, whereby health visitors/midwives referred 4805 clients to money advice services. In another UK before-after study, financial counsellors were attached to urban primary healthcare centres and reported an average annual gain per person of £1058. The randomized controlled trial included in the review reported no evidence of impacts on financial or non-financial outcomes, or maternal health outcomes, but did observe small to moderate effects on child health and well-being. Small to moderate benefits were seen in areas relating to child health, preschool education, parenting, child abuse, and early behavioral adjustment. There was a high level of bias in most studies, and insufficient evidence to evaluate the effectiveness of healthcare-income maximisation models of care. Rigorous (RCT-level) studies with clear evaluations are needed to assess efficacy and effectiveness.


Subject(s)
Child Health , Income , Child , Child, Preschool , Delivery of Health Care , Health Facilities , Health Services , Humans , Infant , Infant, Newborn
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