Not heading in the right direction: Five hundred psychiatrists' views on resourcing, demand, and workforce across New Zealand mental health services.

OBJECTIVE: To explore the views of psychiatrists (including trainees) regarding the current state and future direction of specialist mental health and addictions services in Aotearoa New Zealand. METHODS: Psychiatrists and trainee psychiatrists (registrars) in Aotearoa New Zealand were surveyed in August 2021. Of 879 eligible doctors, 540 participated (83% qualified and 17% trainee psychiatrists), a response rate of over 60%. Data were analysed quantitatively and with content analysis. RESULTS: Psychiatrists thought specialist mental health and addictions services had been neglected during recent reforms, with 94% believing current resourcing was insufficient, and only 3% considering future planning was heading in the right direction. The demand and complexity of on-call work had markedly increased in the preceding 2 years. Ninety-eight percent reported that people needing specialist treatment were often (85%) or sometimes (13%) unable to access the right care due to resourcing constraints. The pressures were similar across sub-specialties. A key theme was the distress (sometimes termed 'moral injury') experienced by psychiatrists unable to provide adequate care due to resource limitations, 'knowing what would be a good thing to do and being unable to do it . . . is soul destroying'. Recommendations were made for addressing workforce, service design and wider issues. CONCLUSION: Most psychiatrists in Aotearoa New Zealand believe the mental health system is not currently fit for purpose and that it is not heading in the right direction. Remedies include urgently addressing identified staffing challenges and boosting designated funding to adequately care for the 5% of New Zealanders with severe mental health and addiction needs.

Improving adult behavioural weight management services for diverse UK Black Caribbean and Black African ethnic groups: a qualitative study of insights from potential service users and service providers.

Background: A significantly higher proportion of UK Black ethnic adults live with overweight or obesity, compared to their White British counterparts. The role of obesity in excess infection rates and mortality from COVID-19 has increased the need to understand if weight management interventions are appropriate and effective for Black ethnic groups. There is a paucity of existing research on weight management services in Black populations, and whether anticipated or experienced institutional and interpersonal racism in the healthcare and more widely affects engagement in these services. Understanding the lived experience of target populations and views of service providers delivering programmes is essential for timely service improvement. Methods: A qualitative study using semi-structured interviews was conducted in June-October 2021 among 18 Black African and Black Caribbean men and women interested in losing weight and 10 weight management service providers. Results: The results highlighted a positive view of life in the United Kingdom (UK), whether born in the UK or born abroad, but one which was marred by racism. Weight gain was attributed by participants to unhealthy behaviours and the environment, with improving appearance and preventing ill health key motivators for weight loss. Participants relied on self-help to address their overweight, with the role of primary care in weight management contested as a source of support. Anticipated or previously experienced racism in the health care system and more widely, accounted for some of the lack of engagement with services. Participants and service providers agreed on the lack of relevance of existing services to Black populations, including limited culturally tailored resources. Community based, ethnically matched, and flexibly delivered weight management services were suggested as ideal, and could form the basis of a set of recommendations for research and practice. Conclusion: Cultural tailoring of existing services and new programmes, and cultural competency training are needed. These actions are required within systemic changes, such as interventions to address discrimination. Our qualitative insights form the basis for advancing further work and research to improve existing services to address the weight-related inequality faced by UK Black ethnic groups.

Valoración y seguimiento de los pacientes con sospecha de COVID-19 en la primera ola pandémica en una zona urbana de Andalucía / Assessment and follow-up of patients with suspected COVID-19 in the first pandemic wave in an urban area of Andalusia (Spain)

Objetivos: Conocer las características de la atención inicial y el seguimiento telefónico de pacientes con sospecha de COVID-19 en la primera ola de la pandemia. Diseño: Observacional retrospectivo (auditoría de historias clínicas).Emplazamiento: Centro de salud urbano. Participantes: Casos probables de SARS-CoV-2 (15/03/2020 a 15/06/2020). Mediciones principales Ámbito de atención inicial y seguimiento telefónico (número de llamadas y duración). Variables sociodemográficas (incluyendo estructura familiar). Curso clínico (sintomatología, vulnerabilidad, pruebas, ingreso hospitalario y desenlace). Resultados Trescientos uno pacientes (51,5 [±17,8] años, 23% vulnerables, 17% estructura familiar no nuclear). Valoración inicial en el centro de salud (59,8%: telefónica; 25,2%: presencial). En urgencias hospitalarias (11%) presentaron síntomas similares que en atención primaria, predominan estructuras familiares no nucleares (p<0,05; test χ2), realizando más pruebas (p<0,05; test χ2). En domicilio (3,9%) son pacientes ancianos vulnerables (p<0,01, test ANOVA). El seguimiento telefónico duró 17,1 [±10,3] días con 8,2 [±4,4] llamadas, superior si provenían de urgencias o domicilio (p<0,03; test ANOVA). Se incrementa tras ≥2 consultas presenciales (OR: 4,8), la presencia de síntomas de alarma (OR: 2,3) y la edad ≥45 años (OR: 2,0). Se realizaron pocas pruebas de confirmación (19,3% antigénicas, 13% serologías). El 15,3% ingresos hospitalarios (todos valorados en centros de salud), con 6,3% casos severos y 2,3% exitus. Conclusión Durante la primera ola de la pandemia, la población optó por ser atendida de forma telemática en su centro de salud. Las valoraciones iniciales en urgencias del hospital se relacionan con la falta de apoyo social, pero no con mayor gravedad clínica. El seguimiento telefónico fue aceptado por la población y permitió seleccionar a los pacientes con peor curso clínico.

ObjectiveTo know the characteristics of the initial care and telephone follow-up of patients with suspected COVID-19 in the first wave of the pandemic. Design: Observational, retrospective (audit of medical records).Location: Urban Primary Care Center of Andalusia (Spain). Participants: Probable cases of SARS-CoV-2 (from 20/03/15 to 20/06/15). Principal measurements Initial medical assessment (place and modality) and telephone follow-up (number of calls and duration). Sociodemographic variables (including family structure). Clinical course (symptoms, vulnerability, tests, hospital admission and outcome). Results Three hundred one patients (51.5±17.8 years; 23% vulnerable people; 17% non-nuclear family structure). First assessment in Primary Care by phone (59.8%) and face-to-face (25.2%). At the hospital emergency department (11%), patients were more frequently from non-nuclear families (P<.05 χ2) and more tests were carried out (P<.05 χ2) despite having similar symptoms. Vulnerable elderly patients needed home health care (P<.01 ANOVA). 8.2±4.4 follow-up phone calls were made per patient, for 17.1±10.3 days. It increases after ≥2 face-to-face consultations (OR 4.8), the presence of alarm symptoms (OR 2.3) and age ≥45 years (OR 2.0). Few confirmatory tests were performed (19.3% antigenic, 13% serology). The 15.3% hospital admissions (all assessed previously in Primary Care), with 6.3% severe cases and 2.3% death. Conclusion Population chose to be attended in Primary Care during the pandemic first wave, above all by phone. Telephone follow-up was well accepted and useful to select patients with serious complications. Initial medical assessment in the hospital emergency department was related to a lack of social support but not with greater clinical severity.

[Assessment and follow-up of patients with suspected COVID-19 in the first pandemic wave in an urban area of Andalusia (Spain)]. / Valoración y seguimiento de los pacientes con sospecha de COVID-19 en la primera ola pandémica en una zona urbana de Andalucía.

OBJECTIVE: To know the characteristics of the initial care and telephone follow-up of patients with suspected COVID-19 in the first wave of the pandemic. DESIGN: Observational, retrospective (audit of medical records). LOCATION: Urban Primary Care Center of Andalusia (Spain). PARTICIPANTS: Probable cases of SARS-CoV-2 (from 20/03/15 to 20/06/15). PRINCIPAL MEASUREMENTS: Initial medical assessment (place and modality) and telephone follow-up (number of calls and duration). Sociodemographic variables (including family structure). Clinical course (symptoms, vulnerability, tests, hospital admission and outcome). RESULTS: Three hundred one patients (51.5±17.8 years; 23% vulnerable people; 17% non-nuclear family structure). First assessment in Primary Care by phone (59.8%) and face-to-face (25.2%). At the hospital emergency department (11%), patients were more frequently from non-nuclear families (P<.05 χ2) and more tests were carried out (P<.05 χ2) despite having similar symptoms. Vulnerable elderly patients needed home health care (P<.01 ANOVA). 8.2±4.4 follow-up phone calls were made per patient, for 17.1±10.3 days. It increases after ≥2 face-to-face consultations (OR 4.8), the presence of alarm symptoms (OR 2.3) and age ≥45 years (OR 2.0). Few confirmatory tests were performed (19.3% antigenic, 13% serology). The 15.3% hospital admissions (all assessed previously in Primary Care), with 6.3% severe cases and 2.3% death. CONCLUSION: Population chose to be attended in Primary Care during the pandemic first wave, above all by phone. Telephone follow-up was well accepted and useful to select patients with serious complications. Initial medical assessment in the hospital emergency department was related to a lack of social support but not with greater clinical severity.

Foster and kinship carer survey: Accessing health services for children in out-of-home care.

AIM: To explore the experiences of Victorian foster and kinship carers in accessing health services for children in their care and to quantify the frequency of potential barriers to health care. METHODS: On-line survey co-designed with the Foster Care Association of Victoria measuring carer-reported health service engagement by a child/young person in their care, ease of service access, time to receiving Medicare number and out-of-pocket health-related costs. A total of 239 foster and 51 kinship carers were recruited through email and social media by carer support agencies. RESULTS: In total, 90% of children/young people had engaged with a general practitioner. Most had engaged with dental (75%), paediatric (72%), optometry (61%) and audiology (54%) services. Mental health services were most likely to be needed but not yet received. Neither carer education nor socio-economic status was associated with likelihood of service engagement. Carers reported that it was hardest to get appointments with mental health and paediatric services. Twenty-seven percent had waited to see a health service because of delays in carers receiving their Medicare number. Sixty percent of carers had paid out-of-pocket for health services; 78% of these had not been reimbursed. CONCLUSION: Victorian foster and kinship carers report high health service use for children and young people in their care. Mental health services were the hardest to access with the largest gap between identified need and service use. Timely access to Medicare numbers and financial support are barriers to access that could be addressed. The development of integrated paediatric health care and clinicians co-located with child protection could also assist.

[Red lines or staffing definition in nursing]. / Untergrenzen oder Personalbemessung in der Pflege.

The lower limits for nursing staff-as red lines to demarcate a dangerous nursing practice-are not suitable for initiating the urgently needed trend reversal to improve staffing in nursing. The German Nursing Staff Strengthening Act sets the right framework conditions for overcoming the shortage of skilled workers by returning to full coverage of nursing staff costs, but this can only be successful if-as required by the Concerted Action on Nursing-the build-up of nursing staff is presented by a procedure for a needs-based nursing staff definition. With the nursing staff regulation PPR 2.0, the German Hospital Association, the worker's union ver.di, and the German Nursing Council have presented a pragmatic but above all immediately usable solution that has been extensively pretested. This interim solution must now be introduced immediately and bindingly in the political process and the path for further scientific development must be initiated. Health care-not only in the current COVID-19 pandemic situation-depends to a large extent on an adequate supply of nursing staff. To also ensure this in the future is the order of the day and binding nurse staffing to a needs-based staff definition are key.

Survey of aged psychiatry services' support of older Australians with very severe, persistent behavioural symptoms of dementia.

OBJECTIVE: To map the provision of community, acute, non-acute and residential care-based state-funded mental health services to older people with severe, persistent behavioural symptoms of dementia. METHODS: An electronic survey was completed in 2015 by senior representatives of aged persons' mental health services across Australia's six states. RESULTS: Jurisdictions varied widely in the number, geographic spread and make-up of aged persons' mental health community teams when adjusted for aged population; their number of acute and non-acute beds, and especially in the provision of specialist residential beds or partnerships with non-government providers. CONCLUSION: There is no nationally accepted pathway of care for this vulnerable group or understanding of what constitutes an adequate statewide mental health service.

What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death.

BACKGROUND: Population ageing represents a global challenge for future end-of-life care. Given new trends in place of death, it is vital to examine where the rising number of deaths will occur in future years and implications for health and social care. AIM: To project where people will die from 2015 to 2040 across all care settings in England and Wales. DESIGN: Population-based trend analysis and projections using simple linear modelling. Age- and gender-specific proportions of deaths in hospital, care home, home, hospice and 'other' were applied to numbers of expected future deaths. Setting/population: All deaths (2004-2014) from death registration data and predicted deaths (2015-2040) from official population forecasts in England and Wales. RESULTS: Annual deaths are projected to increase from 501,424 in 2014 (38.8% aged 85 years and over) to 635,814 in 2040 (53.6% aged 85 years and over). Between 2004 and 2014, proportions of home and care home deaths increased (18.3%-22.9% and 16.7%- 21.2%) while hospital deaths declined (57.9%-48.1%). If current trends continue, numbers of deaths in care homes and homes will increase by 108.1% and 88.6%, with care home the most common place of death by 2040. If care home capacity does not expand and additional deaths occur in hospital, hospital deaths will start rising by 2023. CONCLUSION: To sustain current trends, end-of-life care provision in care homes and the community needs to double by 2040. An infrastructure across care settings that supports rising annual deaths is urgently needed; otherwise, hospital deaths will increase.

Exploring the potential impact of health promotion videos as a low cost intervention to reduce health inequalities: a pilot before and after study on Bangladeshis in inner-city London.

BACKGROUND: Coronary artery disease is the single most common cause of death in the UK. For those born in Bangladesh but dying in England and Wales, coronary artery disease causes 25% of all deaths. Cost-effective solutions are required to address this burden. Several studies have demonstrated the effectiveness of educational video intervention in informing patients in various settings. SETTING: A Bangladeshi women's group in South London. QUESTIONS: The effectiveness of a health educational video in influencing the knowledge and attitudes towards a preventable illness amongst Bangladeshis in London? The scope of videos for health promotion? METHODS: An educational video on the signs, symptoms and prevention of coronary artery disease was played to a Bangladeshi women's group in South London in the Bengali language. Participants (n = 18, mean age = 53.7) completed a fifteen-question survey to assess their baseline knowledge prior to viewing (pre-test). The group then viewed the video and repeated the initial questionnaire, with additional questions to solicit their attitudes and perceptions (post-test). RESULTS: The intervention significantly improved the basic knowledge of coronary artery disease. There was a statistically significant improvement in the number of correct responses amongst participants with p = 0.0002 (mean change 2.28, 95% CI 1.29-3.27) and in the number of unsure responses p = 0.0042 (mean change 1.83, 95% CI 0.01-3.01). Upon viewing the video, all participants agreed that they wanted to implement the advice from the video into their current lifestyles. CONCLUSION/DISCUSSION: The educational video significantly improved the knowledge and attitudes pertaining to coronary artery disease amongst British-Bangladeshi individuals in the UK community setting. This project illustrated how commissioners may effectively utilise third-sector organisations through partnerships to implement innovative methods of health screening and promotion. Videos are a novel approach of providing culturally sensitive health education to ethnic minority groups, through screening in clinics and in local media.

Factors Influencing Intention of Vietnamese to Use Korean Medical Tourism / 간호행정학회지

PURPOSE: The purpose of this study was to identify factors related to Vietnamese customers who use Korean medical and tourism services. The study was based on the Anderson Models METHODS: Participants were 173 Vietnamese who were living in Ho Chi Minh and Hanoi in Vietnam. Data were analyzed using descriptive statistics, χ², t-test and Multiple Logistic Regression. RESULTS: Research necessary factors had the most significant effect among the preceding factors, possible factors and necessary factors. Human service and outstanding natural beauty of necessary factors had significant influence on customer intention to use. According to the result of the stepwise logistic regression analysis, the most important item in medical services was human service OR=1.89 (p=.014), and for tour services, outstanding natural beauty OR=4.30 (p=.033). The explained variance for customer intention to use was 91.9%. CONCLUSION: These results suggest the need to improve the human service and outstanding natural beauty to retain customers' intention to use.