Choosing Or Losing In Behavioral Health: A Study Of Patients' Experiences Selecting Telehealth Versus In-Person Care.

It is not known how the growth of telehealth has affected patients' choice of visit modalities (telehealth versus in person). In 2023 we conducted a mixed-methods study that paired a nationally representative survey of 2,071 adults (including 571 who used behavioral health services) and semistructured interviews with twenty-six people with depression or bipolar disorder. We explored patients' experiences with visit modality selection and their agency in the decision. Approximately one-third of patients receiving therapy or medication visits reported that their clinicians did not offer both modalities. Thirty-two percent reported that they did not typically receive their preferred modality, and 45 percent did not believe that their clinician considered their modality preferences. Qualitative findings revealed that some clinicians did not elicit patients' modality preferences. Perceived lack of choice affected satisfaction and rapport with clinicians and encouraged some people to seek care elsewhere. These findings highlight trade-offs in policies to preserve patient choice and approaches that clinicians can take to identify and accommodate patients' preferences.

Health care leaders' perspectives on the business impact of mobile health clinics.

BACKGROUND: By analyzing how health care leaders in the United States view mobile health programs and their impact on the organization's bottom line, this study equips those who currently operate or plan to deploy mobile clinics with a business case framework. Our aim is to understand health care leaders' perspectives about business-related incentives and disincentives for mobile healthcare. METHODS: We conducted 25 semi-structured key informant interviews with U.S. health care leaders to explore their views and experiences related to mobile health care. We used deductive and inductive thematic analysis to identify patterns in the data. An advisory group with expertise in mobile health, health management, and health care finance informed data collection and analysis. RESULTS: In addition to improving health outcomes, mobile clinics can bolster business objectives of health care organizations including those related to budget, business strategy, organizational culture, and health equity. We created a conceptual framework that demonstrates how these factors, supported by community engagement and data, come together to form a business case for mobile health care. DISCUSSION: Our study demonstrates that mobile clinics can contribute to health care organizations' business goals by aligning with broader organizational strategies. The conceptual model provides a guide for aligning mobile clinics' work with business priorities of organizations and funders. CONCLUSIONS: By understanding how health care leaders reconcile the business pressures they face with opportunities to advance health equity using mobile clinics, we can better support the strategic and sustainable expansion of the mobile health sector.

Estrategias para detectar necesidades farmacoterapéuticas y educacionales de pacientes con riesgo cardiovascular en farmacia comunitaria / Strategies for detecting pharmacotherapeutic and educational needs of patients with cardiovascular risk in community pharmacy

Introducción. Las enfermedades cardiovasculares son la principal causa de mortalidad.Desde la farmacia comunitaria (FC) es posible ayudar a los pacientes a mejorar los factores de riesgo cardiovascular (FRCV) modificables: hipertensión arterial (HTA), dislipemia, diabetes mellitus (DM), tabaquismo y obesidad. Entre los servicios profesionales farmacéuticos relacionados con la salud comunitaria se incluyen este tipo de actuaciones. El objetivo de este estudio ha sido determinar el perfil sociosanitario y farmacoterapéutico de los pacientes con RCV atendidos en la FC española, con el fin de diseñar la intervención más efectiva para ellos. Método: Se realizó un estudio descriptivo de corte transversal entre enero 2017 y febrero 2018. Utilizando un formulario de recogida de datos se registraron los correspondientes a los pacientes de cuatro FC, dos en Sevilla y dos en Badajoz (España) mediante entrevistas individualizadas. Resultados: La muestra inicial (n=100) quedó reducida a 98 pacientes, mayores (61,5±10,1 años), 51,0 % varones, con bajo nivel educativo (53,1 %) y la mayoría de ellos viviendo acompañados (87,8 %). El 74,5 % eran pacientes en prevención primaria y su nivel de RCVmoderado (2,51±1,89). HTA (83,7 %), dislipemia (64,39 %), diabetes II (38,8 %) y obesidad (52,0 %) fueron los factores más prevalentes. Casi la mitad de los pacientes (48,5 %) realizaban ejercicio físico regularmente y el 23,5 % eran fumadores. Los fármacos más consumidos fueron los modificadores de lípidos (59,4 %), antidiabéticos orales (37,5 %), antitrombóticos (32,2 %) y betabloqueantes (28,1 %), Conclusiones: La utilización de formularios encaminados a detectar las necesidades educacionales y farmacoterapéuticas de pacientes con RCV, permitirá establecer diferentes estrategias para mejorar la capacidad de gestionar su enfermedad. (AU)

Introduction: Cardiovascular diseases are the leading cause of mortality, and community pharmacy (CP) can help patients improve modifiable cardiovascular risk factors (CVRF): hypertension (HT), dyslipidaemia, diabetes mellitus (DM), smoking, and obesity. Professional pharmaceutical services related to community health include this type of action. The aim of this study was to determine the socio-health and pharmacotherapeutic profile of patients with CVR treated in Spanish CP, to design the most effective intervention for them.Method: A descriptive cross-sectional study was conducted between January 2017 and February 2018. Using a data collection form, data from patients in four CP, two in Seville and two in Badajoz (Spain) were recorded through individualised interviews.Results: The initial sample (n=100) was reduced to 98 patients, older (61.5±10.1 years), 51.0 % male, with low edu-cational level (53.1 %) and most of them living accompanied (87.8 %). 74.5 % were patients in primary prevention and their CVR level was moderate (2.51±1.89). Hypertension (83.7 %), dyslipidaemia (64.39 %), diabetes II (38.8 %) and obesity (52.0 %) were the most prevalent factors. Almost half of the patients (48.5 %) exercised regularly and 23.5 % were smokers. The drugs most commonly used were lipid modifiers (59.4 %), oral antidiabetics (37.5 %), antithrombotics (32.2 %) and beta-blockers (28.1 %).Conclusions: The use of forms aimed at detecting the educational and pharmacotherapeutic needs of CVR patients will allow one to establish different strategies to improve their ability to manage their disease. (AU)

Resultados negativos asociados a la medicación y reacciones adversas a medicamentos en servicio de urgencias. Estudio exploratorio de vida real / Negative outcomes associated with medication and adverse drug reactions in the emergency department. Real-life exploratory study

Introducción. El objetivo del estudio es determinar la prevalencia de los resultados negativos asociados a la medicación (RNM) y reacciones adversas a medicamentos (RAM) que tienen los pacientes que acuden al servicio de urgencias (SU) de un centro de salud. Método. Estudio observacional exploratorio, de corte transversal, en pacientes con RNM que consultan en un servicio de urgencias. La información, acorde con las variables de interés, se recolectó con un instrumento diseñado y evaluado para ello. Se aplicó un modelo de regresión logística multivariante sobre los RNM encontrados, para determinar las variables más importantes que predisponen a la aparición de RNM. Además, se determinó la evitabilidad de RNM (criterio de Baena et al.), la gravedad de RNM (clasificación de Schneider) y la causalidad de RAM (algoritmo de Naranjo). Resultados. Un total de 158 pacientes fueron incluidos en el estudio. La prevalencia de visitas al SU motivados por RNM fue 35,0 % (55 pacientes) y de RAM fue de 5,1 % (8 pacientes). El 88,0 % de los RNM se consideraron evitables y el 74,0 % fueron de gravedad leve. Por otra parte, el 37,5 % (n=3) de RAM fueron clasificadas como evitables y el 50,0 % como probables. El modelo logístico multivariado indica una posible asociación entre los RNM con bajos niveles de escolaridad, la utilización de plantas medicinales y el número de enfermedades concomitantes. Conclusiones. La visita de 1 de cada 3 pacientes al servicio de urgencias está asociado a un RNM; mientras que 1 de cada 20 lo está a una RAM. Otros estudios son necesarios (AU)

Introduction. The aim of the study is to determine the prevalence of negative outcomes associated with medication (NOMs) and adverse drug reactions (ADRs) occurring in the emergency department (ED) of a health centre.Method. An exploratory observational, cross-sectional study of patients with NOMs consulting in an ED. According to the variables of interest, the information was collected with an instrument designed and evaluated for this pur-pose.A multivariate logistic regression model was applied to the NOMs and found the most important variables predis-posing to the appearance of NOM. In addition, the avoid ability of NOM (Baena et al. criteria), the severity of NOM (Schneider classification) and the causality of ADR (Naranjo algorithm) were shown.Results. A total of 158 patients were included in the study. The prevalence of visits to the ED due to NOM was 35.0 % (55 patients) and ADR was 5.1 % (8 patients). Overall, 88.0 % of the ADRs were considered avoidable and 74.0 % were of mild severity. On the other hand, 37.5 % (n=3) of suspected ADR were classified as avoidable and 50.0 % as probable. The multivariate logistic model indicates a possible association between NOMs with lower levels of schooling, the use of medicinal plants and the number of diseases.Conclusions. The visit of 1 in 3 patients to the emergency department is associated with a NOM, while 1 in 20 is associated with an ADR. Further studies are needed. (AU)

A TurkishInfluencer Physical Educator’s Teacher Agency Reflections on Instagram: A Netnographic Study / Reflexiones de una agencia de profesores de Educación Física influyente turca en Instagram: un estudio netnográfico

Social media holds a significant place in everyday life, where experts in respective fields can share their knowledge. Educators' use of social media attracts attention both for professional development purposes and for the opportunities to benefit students. The purpose of this study was to examine the reflections of a physical educator that use Instagram actively for professional purposes. This is a netnography research in nature, which combines the internet and ethnography. Focusing on a teacher influencer’s experiences, data were collected through a structured interview. Thematic content analysis was carried out with MaxQDA software. According to findings, a physical educator’s journey on social media can be traced to four main themes: the scope of the profile, truthful details, reaction ways, and teaching principles and attitudes. Creating a connection between the content created by a practitioner in the field of physical education and the people who seek and follow meaningful teaching examples makes Instagram a new medium for professional development. (AU)

Las redes sociales ocupan un lugar significativo en la vida cotidiana, donde los expertos en sus respectivos campos pueden compartir su conocimiento. El uso de las redes sociales por parte de los educadores atrae la atención tanto con fines de desarrollo profesional como por las oportunidades de beneficiar a los estudiantes. El propósito de este estudio fue examinar las reflexiones de un educador físico que utiliza activamente Instagram con fines profesionales. Esta investigación se enmarca en una netnografía, que combina internet y etnografía. Centrándose en las experiencias de un influencer docente, se recolectaron datos a través de una entrevista estructurada. Se llevó a cabo un análisis temático del contenido utilizando el software MaxQDA. Según los hallazgos, el recorrido de un educador físico en las redes sociales se puede rastrear en cuatro temas principales: el alcance del perfil, detalles verídicos, formas de reacción y principios y actitudes de enseñanza. La creación de una conexión entre el contenido creado por un profesional en el campo de la educación física y las personas que buscan y siguen ejemplos significativos de enseñanza convierte a Instagram en un nuevo medio para el desarrollo profesional. (AU)

Factores asociados a las infecciones de transmisión sexual en mujeres privadas de la libertad en el Perú / Factors associated with sexually transmitted diseases amongst female prison inmates in Peru

Objetivos: El número de mujeres en condición de prisión se incrementa rápidamente todos los años, por lo que es importante establecer cuáles son los factores que se relacionan con la probabilidad de presentar infecciones de trasmisión sexual (ITS) en esta población para establecer políticas de control sanitario. Material y método: Se realizó un análisis de la base de datos abierta de la encuesta nacional de población penitenciaria del año 2016 realizada en todas las prisiones del Perú. El estudio fue censal y se entrevistaron a todas las mujeres y hombres adultos en situación de cárcel mediante un cuestionario validado. Resultados: La muestra abarcó a 4.574 internas de 67 establecimientos penitenciarios, cubriendo el 98,8% de la población penitenciaria. Se encontró que haber presentado tuberculosis (razón de prevalencia ajustada [RPa]: 1,32; intervalo de confianza [IC] del 95%, 1,32-5,26), presentar virus de la inmunodeficiencia humana (VIH)/sida o síndrome de inmunodeficiencia adquirida (RPa: 1,52; IC del 95%, 1,52-28,18), hepatitis (RPa: 4,01; IC del 95%, 1,23-13,11) y consumo de drogas (Rpa: 2,44; IC del 95%, 1,32-4,52) son factores asociados a la presencia de ITS en el modelo multivariado con un valor p ≤0,05. Discusión: Incluir los factores asociados identificados (tuberculosis, VIH/sida, hepatitis y consumo de drogas) debe ser parte de la estrategia de control y tratamiento de las ITS en las prisiones femeninas del Perú. (AU)

Objectives: The number of women in prison is rapidly increasing every year and it is important to establish what factors are related to the probability of presenting STDs in this population to enable health control policies to be established. Material and method: An analysis was carried out on the open database of the national prison population survey conducted in 2016 in all Peruvian prisons. The study was based on the census and all female and male adults in prison were surveyed using a validated questionnaire. Results: The sample consisted of 4,574 inmates in 67 institutions, covering 98.8% of the inmate population. It was found that presenting tuberculosis (PR: 2.64; CI 95%, 1.32-5.26), HIV/AIDS (PR 6.54, CI 95% 1.52-28.18), hepatitis (PR: 4.01; CI 95%, 1.23-13.11) and drug use (PR: 2.44; CI 95%, 1.32-4.52), are statistically related (P ≤0.05) are factors associated with the presence of STDs in the multivariate model with a P ≤0.05.Discussion: The inclusion of associated factors (tuberculosis, HIV/AIDS, hepatitis and drug use) should be part of the strategy to control and treat STD in women’s prisons in Peru. (AU)

The motives and methods of methamphetamine and 'heroin' co-use in West Virginia.

BACKGROUND: Opioid and methamphetamine co-use is increasing across the USA with overdoses involving these drugs also rising. West Virginia (WV) has led the US in opioid overdose death rates since at least 2013 and rising co-use of methamphetamine with opioids has played a greater role in deaths over the last 5 years. METHODS: This study used rapid ethnography to examine methods and motivations behind opioids and methamphetamine co-use from the viewpoint of their consumers. Participants (n = 30) were people who injected heroin/fentanyl also using methamphetamine who participated in semi-structured interviews. RESULTS: We found multiple methods of co-using opioids and methamphetamine, whether alternately or simultaneously and in varying order. Most prioritized opioids, with motives for using methamphetamine forming three thematic categories: 'intrinsic use', encompassing both inherent pleasure of combined use greater than using both drugs separately or for self-medication of particular conditions; 'opioid assisting use' in which methamphetamine helped people manage their existing heroin/fentanyl use; and 'reluctant or indifferent use' for social participation, reflecting methamphetamine's low cost and easy availability. CONCLUSIONS: Methamphetamine serves multiple functions among people using opioids in WV. Beliefs persist that methamphetamine can play a role in preventing and reversing opioid overdose, including some arguments for sequential use being protective of overdose. 'Reluctant' uptake attests to methamphetamine's social use and the influence of supply. The impact on overdose risk of the many varied co-use patterns needs further investigation.

Mental health and sleep quality of low-income mothers of one-year-olds during the COVID-19 pandemic.

The COVID-19 pandemic and subsequent social restrictions created an unprecedented context for families raising young children. Although studies have documented detrimental effects of the pandemic on maternal well-being, less is known about how the pandemic specifically impacted low-income mothers. We examined depression, anxiety, and sleep quality among low-income mothers of one-year-olds during the early months of the pandemic using data from the Baby's First Years study. Focusing on the control group (n = 547), we compared mothers interviewed before March 14th, 2020 (n = 342) to mothers interviewed between March 14th and June 30th, 2020 (n = 205) to determine whether the pandemic was associated with differences in mental health and sleep quality. Mothers were recruited from four cities in the United States, and most of the sample identified as Hispanic (42.2%) or Black, non-Hispanic (38.6%). We found that mothers interviewed during the pandemic reported better mental health and sleep quality. While we cannot speak to longer-term impacts of the pandemic, it is possible low-income mothers experienced relief from daily stressors during the initial shelter-in-place orders, which may have led to improvements in well-being. These results have implications for understanding how complex life stressors influence mental health and sleep quality among low-income mothers raising young children.

La pandemia del COVID-19 y las subsecuentes restricciones sociales crearon un contexto sin precedentes para las familias que estaban criando niños pequeños. Aunque los estudios han documentado los efectos perjudiciales de la pandemia sobre el bienestar materno, menos se conoce acerca de cómo la pandemia específicamente tuvo un impacto sobre madres de bajos recursos económicos. Examinamos la depresión, ansiedad y calidad del sueño entre madres de bajos recursos económicos de niños de un año de edad durante los primeros meses de la pandemia usando datos del estudio Primeros Años del Bebé. Enfocándonos en el grupo de control (n = 547), comparamos las madres entrevistadas antes del 14 de marzo de 2020 (n = 342) con madres entrevistadas entre el 14 de marzo y el 30 de junio de 2020 (n = 205) para determinar si la pandemia se asociaba con diferencias en salud mental y calidad del sueño. A las madres se les reclutó en cuatro ciudades de Estados Unidos y la mayor parte del grupo muestra se identificaron como Hispanas (42.2%) o Negras no Hispanas (38.6%). Encontramos que las madres entrevistadas durante la pandemia reportaron mejor salud mental y calidad del sueño. A pesar de que no podemos hablar sobre el impacto a largo plazo de la pandemia, es posible que las madres de bajos recursos económicos experimentaran alivio en los factores diarios de estrés durante el inicial mandato de quedarse en su casa, lo cual pudiera haber llevado a mejoras en el bienestar. Estos resultados tienen implicaciones para comprender cómo los complejos factores de estrés influyen en la salud mental y la calidad del sueño entre madres de bajos recursos económicos que crían a niños pequeños.

La pandémie du COVID-19 et les restrictions sociales qui en ont découlé ont créé un contexte sans précédent pour les familles élevant de jeunes enfants. Bien que des études aient documenté des effets préjudiciables de la pandémie sur le bien-être maternel, on en sait moins sur la manière dont la pandémie a spécifiquement impacté les mères de milieux défavorisés. Nous avons examiné la dépression, l'anxiété, et la qualité du sommeil chez des mères de milieux défavorisés avec un enfant d'un an durant les premiers mois de la pandémie, en utilisant des données de l'étude Baby's First Years. Nous concentrant sur le groupe de contrôle (n = 547), nous avons comparé des mères interviewées avant le 14 mars 2020 (n = 342) à des mères interviewées entre le 14 mars et le 30 juin 2020 (n = 205) afin de déterminer si la pandémie était liée à des différences en santé mentale et en qualité de sommeil. Les mères ont été recrutées dans quatre villes des Etats-Unis et la plupart de l'échantillon s'identifiait comme Hispanique (42,2%) ou Noires, non hispaniques (38,6%). Nous avons trouvé que les mères interviewées Durant la pandémie faisaient état d'une meilleure santé mentale et d'une meilleure qualité de sommeil. Bien que nous ne puissions pas parler des impacts de la pandémie à long terme, il est possible que les mères de milieux défavorisés aient fait l'expérience d'un soulagement des facteurs de stress quotidiens durant la période initiale de confinement, ce qui pourrait avoir mené à des améliorations dans le bien-être. Ces résultats ont des implications pour la compréhension de la manière dont des facteurs de stress complexes influencent la santé mentale et la qualité du sommeil chez les mères de milieux défavorisés élevant de jeunes enfants.

Calidad de vida y salud autoevaluada de pacientes sometidos a prostatectomía radical y determinantes sociales de la salud / Qualidade de vida e autopercepção de saúde de pacientes submetidos à prostatectomia radical e os determinantes sociais de saúde / Quality of life and self-perceived health of patients subjected to radical prostatectomy and the social determinants of health

Introducción: La autopercepción de salud y calidad de vida de los hombres sometidos a prostatectomía radical puede ser influenciada por los determinantes sociales de la salud (DSS), por lo tanto, explorar esa relación contribuye al desarrollo de medidas de atención a la salud. Objetivo: Identificar asociaciones entre DSS y calidad de vida y autopercepción de salud en hombres sometidos a prostatectomía radical. Método: Estudio transversal, con análisis cuantitativo, tuvo como participantes hombres sometidos a prostatectomía radical, entrevistados mediante instrumentos para caracterizar el DSS, Calidad de Vida (CV) y autopercepción de salud. Los datos se analizaron mediante estadística descriptiva y correlacional. El estudio fue aprobado por el Comité de Ética en Investigación. Resultados: Participaron 33 hombres, con una edad media de 66,8 años, en su mayoría blancos, con cónyuge, religión y primaria completa o incompleta. Presentaron niveles conservados de CV y autopercepción de salud. La autopercepción de salud se asoció con la religión y la posesión de vivienda, la CV se asoció con la religión, tipo de abordaje quirúrgico, estado civil, tener algún familiar con cáncer de próstata y escolaridad. Conclusión: Hubo una asociación entre DSS y QoL y la salud autopercibida de los hombres sometidos a prostatectomía radical. (AU)

Introdução: A autopercepção de saúde e a qualidade de vida de homens submetidos a prostatectomia radical podem ser influenciadas pelos determinantes sociais de saúde (DSS), portanto, explorar esta essa relação contribui para desenvolver medidas de cuidado em saúde. Objetivo: Identificar as associações dos DSS com a qualidade de vida e autopercepção de saúde de homens submetidos a prostatectomia radical. Método: Estudo transversal, de análise quantitativa, teve como participantes homens submetidos a prostatectomia radical, entrevistados por meio de instrumentos para caracterização dos DSS, Qualidade de Vida (QV) e autopercepção de Saúde. Os dados foram analisados pela estatística descritiva e correlacional. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: Participaram 33 homens, com média de idade de 66,8 anos, a maioria brancos, com cônjuge, religião e ensino fundamental completo ou incompleto. Apresentaram níveis preservados de QV e autopercepção de Saúde. A autopercepção de saúde foi associada a religião e possuir casa própria, a QV foi associada a religião, tipo de abordagem cirúrgica, estado civil, possuir alguém na família com câncer de próstata e escolaridade. Conclusão: Houve associação dos DSS na QV e autopercepção de saúde de homens submetidos a prostatectomia radical. (AU)

Introduction: The self-perception of health and quality of life in men subjected to radical prostatectomy can be influenced by the Social Determinants of Health (SDHs); therefore, exploring this relationship contributes to the development of health care measures. Objective: To identify associations between the SDHs and quality of life and self-perceived health in men subjected to radical prostatectomy. Method: A cross-sectional study with quantitative analysis, which had men subjected to radical prostatectomy as participants, interviewed using instruments to characterize the SDHs, Quality of Life (QoL) and self-perceived health. The data were analyzed using descriptive and correlational statistics. The study was approved by the Research Ethics Committee. Results: The participants were 33 men with a mean age of 66.8 years old, mostly white-skinned, with a spouse, professing some religion and with complete or incomplete Elementary School. They presented preserved levels of QoL and self-perception of health. Self-perceived health was associated with religion and with owning a house; QoL was associated with religion, type of surgical approach, marital status, having someone in the family with prostate cancer and schooling. Conclusion: There was an association between the SDHs and QoL and self-perceived health in men subjected to radical prostatectomy. (AU)

Prevalencia y patrón de consumo de alcohol en pacientes con carcinoma hepatocelular / Prevalence and pattern of alcohol consumption in patients with hepatocellular carcinoma

Objetivo Estudio transversal prospectivo realizado para conocer la prevalencia y el patrón de consumo de alcohol (CA) de los pacientes con carcinoma hepatocelular (CHC) y evaluar la utilidad del AUDIT en estos. Métodos Se incluyeron 102 pacientes consecutivos atendidos en consulta entre febrero y marzo de 2022; se excluyeron aquellos con encefalopatía hepática en el momento de la entrevista, pacientes en lista de espera para trasplante por esta indicación y aquellos en seguimiento postrasplante. Resultados La prevalencia del CA en pacientes con diagnóstico de CHC es del 35%, si bien menos del 10% consume más de 100g de etanol a la semana. El CA fue más frecuente en varones, ambiente urbano, con diagnóstico de CHC hace más de un año y en pacientes en estadio inicial/muy inicial del BCLC. La puntuación AUDIT mayor o igual a 3 (AUROC 0,849) predice cualquier CA con una sensibilidad del 75% (IC 95%: 59,47-90,53%) y con una especificidad del 84% (IC 95%: 74,70-94,05%). Conclusiones A pesar del diagnóstico de CHC, más de un tercio de los pacientes consume alcohol. La puntuación AUDIT igual o mayor de 3 discrimina cualquier CA con una sensibilidad del 75% y una especificidad del 84% en esta población (AU)

Aim Prospective cross-sectional study conducted to determine the prevalence and pattern of alcohol consumption (AC) in patients with hepatocellular carcinoma (HCC) and to assess the utility of the AUDIT in HCC patients. Methods One hundred and two consecutive patients form our HCC monographic outpatient clinic visited between February and March 2022 were included. Patients with hepatic encephalopathy at the time of the interview, on the waiting list for liver transplantation and those undergoing post-transplant follow-up were excluded. Results The prevalence of AC in patients diagnosed with HCC is 35%, although less than 10% consume more than 100g per week. AC was more frequent in males, in an urban environment, with a diagnosis of HCC more than a year ago, and in patients in early/very early stages of BCLC. AUDIT score greater than or equal to 3 (AUROC 0.849) predicts any AC with a sensitivity of 75% (95% CI: 59.47-90.53%) and a specificity of 84% (95% CI: 74.70-94.05%). Conclusions Despite the diagnosis of HCC, more than a third of the patients consume alcohol. An AUDIT score equal to or greater than 3 discriminates any AC with a sensitivity of 75% and a specificity of 84% in this population (AU)

Maternal mental health screening and management by health workers in southwestern Uganda: a qualitative analysis of knowledge, practices, and challenges.

BACKGROUND: Maternal mental health (MMH) problems, such as perinatal depression, maternal anxiety, suicide ideation and puerperal psychosis among others, have a significant impact on maternal morbidity and mortality, as well as the health and development of children. One in every four pregnant women and one in every five postpartum women in low-income countries, suffer from maternal mental health (MMH) problems. Despite this, MMH screening, diagnosis, and reporting remain scanty in Uganda. Consequently, this study aimed to investigate the knowledge, practices, and impediments that maternity care workers face when screening and managing women with maternal mental health disorders in health facilities in south-western Uganda. METHODS: In-depth interviews were conducted with 22 health-care professionals who work in maternity care departments in primary and tertiary healthcare facilities in southwestern Uganda to investigate their medical knowledge, clinical practices, and challenges related to the screening and management of maternal mental health problems. Using qualitative content analysis, distinct categories and subcategories were found. RESULTS: Medical staff especially midwives lacked specialized training in screening and managing women with maternal mental health problems They screened and managed MMH problems solely based on history and physical examination, and they referred nearly every mother displaying signs of mental illness because they felt ill-prepared to handle them. On the other hand, medical staff with some level of specialized training in mental health particularly staff working in mental health units, were more likely to use a mental health screening tool in addition to history and physical examination; and to treat any women exhibiting signs and symptoms of maternal mental problems without referring them. Lack of in-service training on maternal mental health, poorly coordinated referral systems, reluctance of mentally ill to visit medical facilities, scarcity of mental health specialists, and shortage of relevant medications were identified as the major challenges. Age, experience level, or gender had no effect on screening or management practices. CONCLUSIONS: The results suggest that specialized training in mental health, and particularly maternal mental health, is essential for the effective screening and management of maternal mental health conditions in South Western Uganda.

Inheritance and inequality among nomads of South Siberia.

At the headwaters of the Yenisei River in Tuva and northern Mongolia, nomadic pastoralists move between camps in a seasonal rotation that facilitates their animals' access to high-quality grasses and shelter. The use and informal ownership of these camps depending on season helps illustrate evolutionary and ecological principles underlying variation in property relations. Given relatively stable patterns of precipitation and returns to capital improvement, families generally benefit from reusing the same camps year after year. We show that locations with higher economic defensibility and capital investment-winter camps and camps located in mountain/river valleys-are claimed and inherited more frequently than summer camps and camps located in open steppe. Camps are inherited patrilineally and matrilineally at a ratio of 2 : 1. Despite its practical importance, camp inheritance is not associated with livestock wealth today, which is better predicted by education and wealth outside the pastoral economy. The relationship between the livestock wealth of parents and their adult children is significantly positive, but relatively low compared to other pastoralists. The degree of inequality in livestock wealth, however, is very close to that of other pastoralists. This is understandable considering the durability and defensibility of animal wealth and economies of scale common across pastoralists. This article is part of the theme issue 'Evolutionary ecology of inequality'.

A qualitative quantitative mixed methods study of domestic violence against women.

BACKGROUND: Violence against women is one of the most widespread, persistent and detrimental violations of human rights in today's world, which has not been reported in most cases due to impunity, silence, stigma and shame, even in the age of social communication. Domestic violence against women harms individuals, families, and society. The objective of this study was to investigate the prevalence and experiences of domestic violence against women in Semnan. METHODS: This study was conducted as mixed research (cross-sectional descriptive and phenomenological qualitative methods) to investigate domestic violence against women, and some related factors (quantitative) and experiences of such violence (qualitative) simultaneously in Semnan. In quantitative study, cluster sampling was conducted based on the areas covered by health centers from married women living in Semnan since March 2021 to March 2022 using Domestic Violence Questionnaire. Then, the obtained data were analyzed by descriptive and inferential statistics. In qualitative study by phenomenological approach and purposive sampling until data saturation, 9 women were selected who had referred to the counseling units of Semnan health centers due to domestic violence, since March 2021 to March 2022 and in-depth and semi-structured interviews were conducted. The conducted interviews were analyzed using Colaizzi's 7-step method. RESULTS: In qualitative study, seven themes were found including "Facilitators", "Role failure", "Repressors", "Efforts to preserve the family", "Inappropriate solving of family conflicts", "Consequences", and "Inefficient supportive systems". In quantitative study, the variables of age, age difference and number of years of marriage had a positive and significant relationship, and the variable of the number of children had a negative and significant relationship with the total score and all fields of the questionnaire (p < 0.05). Also, increasing the level of female education and income both independently showed a significant relationship with increasing the score of violence. CONCLUSIONS: Some of the variables of violence against women are known and the need for prevention and plans to take action before their occurrence is well felt. Also, supportive mechanisms with objective and taboo-breaking results should be implemented to minimize harm to women, and their children and families seriously.

Psychosocial resources underlying disaster survivors' posttraumatic stress symptom trajectories: insight from in-depth interviews with mothers who survived Hurricane Katrina.

Background: Weather-related disasters, including hurricanes, are becoming more frequent and severe due to climate change. Vulnerable populations, such as people with low income and racial and ethnic minorities, are particularly prone to increased levels of physical harm and psychiatric adversity from weather-related events.Objectives: We aimed to explore psychosocial resources and coping of survivors with three different posttraumatic stress symptom (PTSS) trajectories (High-Decreasing, Moderate-Decreasing, and High-Stable), after Hurricane Katrina across two different time points: F1 (1-year post-disaster) and F3 (12 years post-disaster).Method: Participants in this multi-method study were part of a larger cohort of the Resilience in Survivors of Katrina (RISK) project. Transcripts of interviews completed at the two time points were analysed using two qualitative methods, combining thematic analysis and narrative analysis, and providing both breadth of perspectives with the depth of specific case studies.Results: Sixteen survivors completed interviews at both F1 and F3. From our in-depth analysis of the data, we derived five inductive themes: 'Hope,' 'Adaptive vs maladaptive avoidance,' 'Emotional delay,' 'Acceptance, Finding Meaning and Being in the Moment,' and 'Coping strategies.' Survivors with High-Decreasing and Moderate-Decreasing PTSS trajectories experienced hope for future, accepted the hurricane and its results, and found efficient ways to cope with their situation. Survivors with High-Stable PTSS trajectories tended to express a lack of hope for future and struggled to be mindful and accept the hurricane and its harm. Unlike survivors with High-Decreasing and Moderate-Decreasing PTSS trajectories, survivors with High-Stable PTSS trajectories also reported less social and family support and faced more discrimination and racism.Conclusion: There are factors beyond individual-level psychosocial resources that may shape post-disaster resilience. When supporting survivors after a weather-related disaster, it is essential to provide ongoing psychological, financial, and physical assistance to bolster these resources.

After Hurricane Katrina, survivors with different posttraumatic stress symptom trajectories reported different levels of hope, mindfulness, and willingness to talk about the hurricane, emotional processing, and coping strategies.These experiences varied over time for survivors in all three trajectories.Survivors who report ongoing high levels of symptoms should be offered additional support to bolster these psychosocial resources.

Adolescent Cyberbullies' Attributions: Longitudinal Linkages to Cyberbullying Perpetration.

The aim of the present study was to examine cyberbullies' attributions pertaining to their perpetration of cyberbullying, and how such attributions relate to their cyberbullying behaviors six months later. Participants were 216 adolescents (M = 13.46, SD = 0.62 years; 55% female) from the suburbs of a large Midwestern city in the United States. They were interviewed face-to-face in the fall of 2018 concerning why they acted in negative ways toward peers online or through text messages. They also answered questionnaires regarding how often they perpetrated face-to-face bullying and cyberbullying during the fall of 2018 and spring of 2019. The attributions of revenge, convenience, anger, and anonymity each predicted cyberbullying at the second time point while controlling for face-to-face bullying perpetration. Results from this study provide important information to the literature regarding cyberbullies' attributions for perpetrating cyberbullying, and how such attributions predict future cyberbullying perpetration. These findings are important for the development of antibullying programs that might aim to change adolescents' attributions for cyberbullying perpetration to reduce continued engagement in these behaviors.

The feasibility of daily monitoring in adolescents and young adults with mild intellectual disability or borderline intellectual functioning.

BACKGROUND: It is unclear whether the limitations of young persons with a mild intellectual disability or borderline intellectual functioning preclude feasibility of the daily diary method. METHOD: For 60 consecutive days, 50 participants (Mage = 21.4, 56% male) who receive care in an ambulatory, residential, or juvenile detention setting, self-rated both standardised and personalised diary questions through an app. Diary entries were used for feedback in treatment. Interviews were used to explore acceptability. RESULTS: Average compliance was 70.4%, while 26% of participants dropped out. Compliance was good in ambulatory (88.9%) and residential care (75.6%), but not in the juvenile detention setting (19.4%). The content of self-selected diary items varied widely. Participants deemed the method acceptable. CONCLUSIONS: Daily monitoring is feasible for individuals with a mild intellectual disability or borderline intellectual functioning receiving ambulatory or residential care, and can provide scientists and practitioners with important insights into day-to-day behavioural patterns.

The Psychosocial Impact of Treating Patients with COVID-19 on Psychiatry Residents in a Community Hospital: a Qualitative Study.

OBJECTIVE: The authors explored the experiences of psychiatry residents caring for patients during the COVID-19 pandemic on a medical unit. METHODS: From June 2020 through December 2020, structured, individual interviews were conducted with psychiatry residents deployed to internal medicine wards in a community hospital to provide medical care to COVID-19 patients for greater than or equal to 1 week. Interviews were recorded, transcribed verbatim, and analyzed using thematic analytical methods. RESULTS: Psychiatry residents (n = 16) were interviewed individually for approximately 45 min each. During the interviews, many residents described emotions of fear, anxiety, uncertainty, lack of preparedness, and difficulty coping with high patient mortality rates. Many of the residents expressed concerns regarding insufficient personal protective equipment, with the subsequent worries of their own viral exposure and transmission to loved ones. Multiple residents expressed feeling ill-equipped to care for COVID-19 patients, in some cases stating that utilizing their expertise in mental health would have better addressed the mental health needs of colleagues and patients' families. Participants also described the benefits of processing emotions during supportive group sessions with their program director. CONCLUSIONS: The COVID-19 pandemic represents a public health crisis with potential negative impacts on patient care, professionalism, and physicians' well-being and safety. The psychiatry residents and fellows described the overwhelmingly negative impact on their training. The knowledge gained from this study will help establish the role of the psychiatrist not only in future crises but in healthcare as a whole.

Evaluation of an Innovative Colon Capsule Endoscopy Service in Scotland From the Perspective of Patients: Mixed Methods Study.

BACKGROUND: Colonoscopy is the gold standard for lower gastrointestinal diagnostics. The procedure is invasive, and its demand is high, resulting in long waiting times. Colon capsule endoscopy (CCE) is a procedure that uses a video capsule to investigate the colon, meaning that it can be carried out in a person's own home. This type of "hospital-at-home" service could potentially reduce costs and waiting times, and increase patient satisfaction. Little is currently understood, however, about how CCE is actually experienced and accepted by patients. OBJECTIVE: The aim of this study was to capture and report patient experiences of the CCE technology (the capsule and associated belt and recorder) and of the new clinical pathway for the CCE service being rolled out as part of routine service in Scotland. METHODS: This was a mixed methods service evaluation of patient experiences of a real-world, deployed, managed service for CCE in Scotland. Two hundred and nine patients provided feedback via a survey about their experiences of the CCE service. Eighteen of these patients took part in a further telephone interview to capture more in-depth lived experiences to understand the barriers and opportunities for the further adoption and scaling up of the CCE service in a way that supports the patient experience and journey. RESULTS: Patients overall perceived the CCE service to be of significant value (eg, mentioning reduced travel times, reduced waiting times, and freedom to complete the procedure at home as perceived benefits). Our findings also highlighted the importance of clear and accessible information (eg, what to expect and how to undertake the bowel preparation) and the need for managing expectations of patients (eg, being clear about when results will be received and what happens if a further colonoscopy is required). CONCLUSIONS: The findings led to recommendations for future implementations of managed CCE services in National Health Service (NHS) Scotland that could also apply more widely (United Kingdom and beyond) and at a greater scale (with more patients in more contexts). These include promoting CCE with, for, and among clinical teams to ensure adoption and success; capturing and understanding reasons why patients do and do not opt for CCE; providing clear information in a variety of appropriate ways to patients (eg, around the importance of bowel preparation instructions); improving the bowel preparation (this is not specific to CCE alone); providing flexible options for issuing and returning the kit (eg, dropping off at a pharmacy); and embedding formative evaluation within the service itself (eg, capturing patient-reported experiences via surveys in the information pack when the equipment is returned).

Escalation to intensive care for the older patient. An exploratory qualitative study of patients aged 65 years and older and their next of kin during the COVID-19 pandemic: the ESCALATE study.

BACKGROUND: older people comprise the majority of hospital medical inpatients so decision-making regarding admission of this cohort to the intensive care unit (ICU) is important. ICU can be perceived by clinicians as overly burdensome for patients and loved ones, and long-term impact on quality of life considered unacceptable, effecting potential bias against admitting older people to ICU. The COVID-19 pandemic highlighted the challenge of selecting those who could most benefit from ICU. OBJECTIVE: this qualitative study aimed to explore the views and recollections of escalation to ICU from older patients (aged ≥ 65 years) and next of kin (NoK) who experienced a COVID-19 ICU admission. SETTING: the main site was a large NHS Trust in London, which experienced a high burden of COVID-19 cases. SUBJECTS: 30 participants, comprising 12 patients, 7 NoK of survivor and 11 NoK of deceased. METHODS: semi-structured interviews with thematic analysis using a framework approach. RESULTS: there were five major themes: inevitability, disconnect, acceptance, implications for future decision-making and unique impact of the COVID-19 pandemic. Life was highly valued and ICU perceived to be the only option. Prior understanding of ICU and admission decision-making explanations were limited. Despite benefit of hindsight, having experienced an ICU admission and its consequences, most could not conceptualise thresholds for future acceptable treatment outcomes. CONCLUSIONS: in this study of patients ≥65 years and their NoK experiencing an acute ICU admission, survival was prioritised. Despite the ordeal of an ICU stay and its aftermath, the decision to admit and sequelae were considered acceptable.

Análise do Efeito da Idade Relativa e do ano constituinte nas categorias de base do atletismo / Análisis del efecto de la edad relativa y el año constitutivo en las categorías básicas de atletismo / Analysis of the effect of relative age and constituent year on basic athletics categories

El presente estudio buscó analizar el Efecto de la Edad Relativa y el año constituyente en las categorías básicas del atletismo. Se decidió realizar un análisis del ranking general CBAt, tomando como muestra los datos de 2017. El enfoque de análisis consistió en un enfoque cuantitativo y cualitativo. La muestra estuvo compuesta por un total de 3.909 deportistas, hombres y mujeres, nacidos en los siguientes años: 1996 (n = 268); 1997 (n = 680); 1998 (n = 630); 1999 (n = 910); 2000 (n = 572); 2001 (n = 612); 2002 (n = 204); y 2003 (n = 33). Además, se entrevistó a seis entrenadores brasileños en la modalidad de atletismo para contribuir a las discusiones. Se puede observar que existe una tendencia a que el ranking deportivo de las categorías del base tenga una mayor sobrerrepresentación de los deportistas nacidos en los primeros meses del año, en relación a los nacidos en los últimos meses. Por otro lado, otro tema observado es que el año constitutivo de las categorías analizadas (16, 18 y 20 años) no tiene la mayoría de los resultados. Por tanto, son cuestiones que deben ser tenidas en cuenta por las personas que trabajan en el proceso de formación deportiva. (AU)

The present study sought to analyze the Effect of Relative Age and the constituent year in the basic categories of athletics. It was decided to carry out an analysis of the general CBAt ranking, taking the 2017 data as a sample. The analysis approach consisted of a quantitative and qualitative approach. The sample included a total of 3,909 athletes, male and female, born in the following years: 1996 (n = 268); 1997 (n = 680); 1998 (n = 630); 1999 (n = 910); 2000 (n = 572); 2001 (n = 612); 2002 (n= 204); and 2003(n = 33). In addition, six Brazilian coaches in the athletics modality were interviewed in order to contribute to the discussions. It is noticed that there was a tendency for the sports ranking of the basic categories to have agreater representation of athletes born in the first months of the year, in relation to those born in the final months. On the other hand, another issue observed is that the constituent year of the analyzed categories (16, 18 and 20 years) does not have the majorityof the results. Thus, these are issues that need to be taken into account by the people who work in the sports training process. (AU)

O presente estudo buscou analisar o Efeito da Idade Relativa e do ano constituinte nas categorias de base do atletismo. Optou-se em fazer uma análise do ranking geral da CBAt, tendo como amostra os dados de 2017. A abordagem de análise consistiu em uma abordagem quanti-qualitativa. Fizeram parte da amostra um total de 3.909 atletas, dos sexos masculino e feminino, nascidos nos seguintes anos: 1996 (n=268); 1997 (n=680); 1998 (n=630); 1999 (n=910); 2000 (n=572); 2001 (n=612); 2002 (n=204); e 2003(n=33). Além disto, seis técnicos brasileiros da modalidade de atletismo foram entrevistados com o intuito de contribuir para as discussões. Percebe-se que houve uma tendência de o ranking esportivo das categorias de base ter uma maior representação de atletas nascidos nos primeiros meses do ano, em relação aos nascidos nos meses finais. Por outro lado, outra questão observada, é que o ano constituinte das categorias analisadas (16, 18 e 20 anos) não possui a maioria dos resultados. Deste modo, essas são questões que precisam ser levadas em consideração pelas pessoasque atuam no processo de formação esportiva. (AU)