Co-production of a mobile application for parents of acutely ill children under five: 'iPoorly child symptom checker'.

BackgroundFollowing the armed conflict in Tigray, the health system collapsed and routine health services were interrupted. However, after the Pretoria peace agreement, various health -related interventions aimed at recovery were implemented. Despite these efforts, little is known about the current status of child health services, including immunization and healthcare seeking for childhood illnesses. Therefore, this study aimed to evaluate child health services in post-war Tigray.MethodsA community and facility-based cross-sectional study was conducted from January to February 2024 to assess the uptake of child health services and service readiness among mothers of children aged 0–59 months (N = 2340). A multistage sampling technique was used, with a random selection of 24 districts and 78 sub-districts, and 30 households were considered per Tabia based on the assumption of Ethiopian Demographic Health Survey, 2019. A representative sample of health facilities (30%) including primary hospitals, health centers and health posts, was also considered. Data were collected using Open Data Kit (ODK), which was pretested, modified, and translated into the local language. The collected data were cleaned, coded, and analyzed using SPSS version 25.ResultsThe response rate of this study was 99.9%. The proportion of children who received full vaccination was 58.8%, with a significant disparity between urban and rural areas. A significant difference was noted in the full vaccine uptake among contraceptive users (65.7%) (p-value < 0.007) and by residence urban (66.8%) versus rural (56.3%) (p-value < 0.006). Cough was the leading cause of childhood illnesses, followed by fever in the rural settings accompanied by the healthcare seeking of 58.6%, 48.4%, 59.3% for diarrhea, cough and fever respectively. The overall readiness score for child health and specific EPI service were 46.4% and 37.4% respectively.ConclusionIn the post- war period, immunization coverage in Tigray was relatively low, with a notable urban–rural disparity. Utilization of healthcare for childhood illness was also low in rural communities despite the high burden of diseases. Overall, readiness score for child health and immunization services were low. Concerted efforts are needed to improve the uptake of childhood vaccines and the readiness score for child health services.

Prostate cancer survivors appear to have higher rates of seeking medical help for erectile dysfunction (ED) than other cohorts of sexually dysfunctional men; however, factors associated with help-seeking for ED after prostate cancer have not been investigated. A group of 1,188 men with ED after prostate cancer responded to a postal survey about their sexuality, including a new questionnaire developed to measure traditional masculine attitudes about sex that could inhibit help-seeking. Respondents had a mean age of 68 years and were an average of 4.3 years postdiagnosis of cancer. At the time of the survey, 46% had sought medical help for ED since their cancer treatment and 44% intended to seek help in the next year. A hierarchical backward selection logistic regression analysis was performed to determine factors correlated with seeking help for ED after prostate cancer. Blocks of factors were entered in to the analysis in order. Factors significant within each step were retained when calculating a final model. Out of 37 factors entered into the model, three retained significance: Men who sought help for ED were more likely to have had a prostate cancer treatment designed to spare sexual function and reported higher distress about postcancer ED. Even with all other factors taken into account, men who had more positive attitudes on the Help-Seeking Questionnaire were significantly more likely to have sought help for ED. A second logistic regression analysis examined correlates of intent to seek help for ED within the next year. Out of 38 factors entered into the analysis, six retained significance in the final model: Men intending to seek help had been treated more recently for their prostate cancer, were more dissatisfied with their sexual function, had higher levels of distress about postcancer ED and loss of sexual desire, and were more likely to have sought help for ED even before their prostate cancer was diagnosed. Even with these factors taken into account, positive attitudes on the Help-Seeking Questionnaire were significantly associated with help-seeking intentions. These results suggest that cognitive-behavioral interventions designed to challenge men's negative beliefs about seeking help for ED could potentially increase help-seeking behavior.

Study: To compare care seeking and non-care seeking couples with infertility in order to describe potential differences which may have consequences for health care planning and research. Design: multicentre surveys of randomly selected women of child-bearing age. Setting: seven centres in five countries: Denmark, Germany (two centres), Italy (two centres), Poland and Spain. Data were collected from 1991 to 1993 as part of a European concerted action. Participants: population-based samples of women between 25 and 44 years. The samples ranged from 442 women in Poland to 2, 729 women in Italy. The participation rates ranged from 54% in Germany to 88% in Poland. Data: data were collected during face to face interviews by means of highly structured questionnaires. Questions were asked about life style factors, work exposures, pregnancy history, fecundity and care seeking behaviour. Main outcome measures: seeking medical advice and help for infertility among couples who had tried to become pregnant for more than 12 months. Main results: nulliparity was the strongest predictor for seeking help in all the European centres and more than 50% of the nulliparous women sought help in all the centres. The frequency of care seeking among couples with secondary infertility varied to a large extent between the different centres. Women with a paid job and smokers were less likely to seek help in most centres (except in Spain and Italy). Conclusion: far from all those with an infertility problem seek medical advice and help, and the correlates of care seeking differ to a large extent between different cultural and health care settings. Research based upon clinical samples could easily be biased if the topic of research correlates with care seeking behaviour.

Medical activity of patients, including timely seeking medical help and adherence to recommendations, plays a key role in the early detection of diseases. The relationship between the medical and social characteristics of patients, their activity, and the timeliness of diagnosis remains insufficiently studied. The aim of the study is to study the impact of patients’ medical activity on the timing of COVID‑19 diagnosis and identify ways to improve it. Materials and methods. A survey and analysis of the medical records of 1820 COVID‑19 patients (U07.1), who sought outpatient care in Bashkortostan (December 2020 – March 2021), were conducted. Patients under 18 years old, pregnant women, those who did not consent to participate, and those with incomplete questionnaires were excluded. The study examined medical and social characteristics (gender, age, marital status, education, comorbidities, etc.) and the level of medical activity before the illness. Patients were divided into three activity groups: low, medium, and high. The organization of COVID‑19 diagnostics was assessed: time of seeking help, diagnosis, treatment, and duration of sick leave. The distribution of patients was analyzed by gender and age groups (up to 39 years, 40–60 years, over 60 years). Statistical data processing was performed using the student’s t-test (p &lt; 0.05) in Microsoft Excel and IBM SPSS Statistics (version 26). Results. The study showed that 33.8% of patients were under 39 years old, 39.0% were aged 40–60 years, and 27.2% were over 60 years old. 60.2% of patients worked in intellectual labor, with a higher proportion among women (63.8%). According to the survey, 39.4% of patients with chronic diseases sought medical help untimely, with this figure being higher among men (42.1%). The highest proportion of timely visits was observed among patients over 60 years old (42.1%). Among the respondents, 55.7% were registered with a dispensary, 37.6% of them regularly underwent preventive examinations, and 41.8% ignored them. Women were more likely to have regular checkups, while men were less likely. 51.1% of patients fully followed the doctor’s recommendations, 27.0% partially followed them, and 21.9% did not follow them. Younger patients (under 39 years) were more likely to not adhere to recommendations. High medical activity was observed in 40.8% of patients, medium activity in 22.1%, and low activity in 37.2%. Women had higher activity levels more frequently, while men had lower activity levels. Most patients sought medical help on the 4th‑6th day of illness (50.3%), with men having a lower proportion than women. Diagnoses were more often made within 1–3 days after being ordered (60.1%), and treatment started on the day of diagnosis or within 1–3 days for 95.4% of patients. A larger proportion of patients were on sick leave for 8 to 14 days (51.4%). Patients with high medical activity sought help earlier (1–3 days), had research conducted on the same day, and began treatment on the same day. At the same time, patients with low activity sought help later, waited longer for diagnostics and treatment, and had longer periods of sick leave. Findings. The results show that patients with high medical activity receive medical help at earlier stages of the disease, which leads to faster diagnosis and treatment. On the other hand, patients with low activity seek help later, leading to delays in diagnostics, treatment, and longer periods of sick leave.

Reasons for medical help-seeking behaviour of patients with recent-onset arthralgia

BackgroundChildhood illnesses and mortality rates have declined over the past years in sub-Saharan African countries; however, under-five mortality is still high in the region. This study investigated the magnitude and factors associated with health care seeking behaviour for children with childhood illnesses in 24 sub-Saharan African countries.MethodsWe used secondary data from Demographic and Health Surveys (DHSs) conducted between 2013 and 2018 across the 24 sub-Saharan African countries. Binary logistic regression models were applied to identify the factors associated with health care seeking behaviour for children with acute childhood illnesses. The results were presented using adjusted odds ratios (aOR) with 95% confidence intervals (CIs).ResultsOverall, 45% of children under-5 years with acute childhood illnesses utilized health care facilities. The factors associated with health care seeking behaviour for children with acute illnesses were sex of child, number of living children, education, work status, wealth index, exposure to media and distance to a health facility.ConclusionsOver half of mothers did not seek appropriate health care for under-five childhood illnesses. Effective health policy interventions are needed to enhance health care seeking behaviour of mothers for childhood illnesses in sub-Saharan African countries.

Uncertainty and anxiety surround parents' decisions to seek medical help for an acutely ill child. Consultation rates for children are rising, yet little is known about factors that influence parents' help-seeking behaviours. We used focus groups and interviews to examine how 27 parents of children under five years, from a range of socioeconomic groups in the East Midlands of England, use information to make decisions during acute childhood illness at home. This article reports findings elucidating factors that influence help-seeking behaviours. Parents reported that decision-making during acute childhood illness was influenced by a range of personal, social and health service factors. Principal among these was parents' concern to do the right thing for their child. Their ability to assess the severity of the illness was influenced by knowledge and experience of childhood illness. When parents were unable to access their general practitioner (GP), feared criticism from or had lost trust in their GP, some parents reported using services elsewhere such as Accident and Emergency. These findings contribute to explanatory theory concerning parents' help-seeking behaviours. Professional and political solutions have not reduced demand; therefore, collaborative approaches involving the public and professionals are now needed to improve parents' access to information.

This paper aims to report our experience of developing, implementing, and evaluating myHealthE (MHE), a digital innovation for Child and Adolescents Mental Health Services (CAMHS), which automates the remote collection and reporting of Patient-Reported Outcome Measures (PROMs) into National Health Services (NHS) electronic healthcare records. We describe the logistical and governance issues encountered in developing the MHE interface with patient-identifiable information, and the steps taken to overcome these development barriers. We describe the application's architecture and hosting environment to enable its operability within the NHS, as well as the capabilities needed within the technical team to bridge the gap between academic development and NHS operational teams. We present evidence on the feasibility and acceptability of this system within clinical services and the process of iterative development, highlighting additional functions that were incorporated to increase system utility. This article provides a framework with which to plan, develop, and implement automated PROM collection from remote devices back to NHS infrastructure. The challenges and solutions described in this paper will be pertinent to other digital health innovation researchers aspiring to deploy interoperable systems within NHS clinical systems.

Significant resources are used for acute illnesses in children. Identifying predictors of resource use can focus interventions to reduce this use. To determine the relative effects of maternal, infant, social milieu, and demographic characteristics, the mother-child interaction, and perception of illness severity on the use of resources during acute illnesses in children. At the 2-week and 6-, 15-, and 24-month well-child care visits of a cohort of mother-infant dyads, the mother-well-child interaction was assessed by using the Biringen Emotional Availability Scales, and data were gathered regarding maternal depression and sense of competence, infant temperament, maternal social support, the home environment, and demographic characteristics. At each of the cohort's 1983 ill-child care visits during 30 months of follow-up, the mother-ill-child interaction was assessed by using the Emotional Availability Scales, and mothers and pediatricians independently assessed illness severity using the Acute Illness Observation Scales. Resources used during the illnesses-over-the-counter and prescription medications, tests, hospitalizations, follow-up visits, and the emergency department-were assessed. A hospital primary care center and an urban and a suburban private practice. Patients Between February 1, 1995, and March 30, 1998, a consecutive sample of 380 dyads were asked to enroll at the 2-week well-child care visit; 316 (83.2%) consented, and complete data were available for analysis of 243 dyads. A path analytic framework using a structural equation model assessed the presence and strength of predictive relationships between demographic, maternal, infant, and social milieu data, the Biringen Emotional Availability Scales, and the Acute Illness Observation Scales and the main outcome measure, resource use. Three variables predicted greater mean resource use during each acute illness episode: a less optimal mother-child interaction (beta = -.53), lower scores for parenting sense of competence (beta = -.26), and greater perception of illness severity by mothers (beta =.33). By using the coefficient of determination (R2), these 3 predictors account for 55% of the reliable variance in resource use during acute illnesses. The quality of the mother-child interaction, maternal sense of competence, and maternal assessment of severity of the illness are major predictors of resource use during acute pediatric illnesses, and should be important foci of interventions to reduce resource use.

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers.

La regulacion laboral del trabajo en contratas y subcontratas de obras y servicios constituye uno de los pasajes mas frecuentados y al mismo tiempo mas problematicos de nuestro Derecho del Trabajo, con multiples acercamientos doctrinales e infinidad de pronunciamientos jurisprudenciales. Aunque su centro de imputacion sigue siendo el articulo 42 ET, hoy en dia tal precepto -que fue objeto de modificacion parcial y ampliacion por parte de la Ley 12/2001- no es mas que uno entre los muchos que componen este segmento normativo, del que forman parte tambien otras numerosas previsiones, que en general actuan como ramas complementarias (o de refuerzo) de ese imprescindible soporte legal, pero que en muchos casos tratan de responder a problemas mas especificos o sectoriales; estamos, a la postre, ante un regimen juridico un tanto disperso y bastante variado, plural en cuanto a sus fines y complejo en su estructura, y con alguna deficiencia desde el punto de vista sistematico, sin que, por otra parte, hayan desaparecido del todo sus tradicionales dificultades interpretativas y de aplicacion. El presente comentario ha optado por una exposicion de sintesis, integrada sobre todo por reflexiones de orden general, orientadas principalmente hacia la estructura y las lineas de regulacion del normativo vigente. Desde esa perspectiva de analisis, el punto de partida ha de situarse de manera inevitable en la creciente complejidad de la norma (el sistema normativo ), que hace ya algun tiempo dejo de preocuparse en exclusiva por la proteccion salarial y de Seguridad Social de los trabajadores implicados para tratar de proporcionarles tambien una adecuada tutela en el ambito de la seguridad y salud en el trabajo, y que progresivamente ha ido perfilando y engrosando los instrumentos de caracter sancionador para la efectiva aplicacion de las correspondientes previsiones normativas. Tras ello nos detendremos en la delimitacion de la realidad empresarial subyacente (el supuesto de hecho), que no es otra que la contrata o subcontrata de obras y servicios, pero que sigue sin contar con una definicion clara y precisa dentro de la norma laboral. Por ultimo atenderemos al interior de la norma (el contenido, esencial o adicional), para hacer un breve recorrido por los tres tipos de reglas que la componen: obligaciones preventivas, responsabilidades y deberes de informacion a los trabajadores y a sus representantes.

To compare parents of children with special health care needs (CSHCN) with other parents to determine parents' expectations and priorities for discussing concerns related to a child's acute or chronic illness at well-child care visits, the association of unmet expectations and priorities with satisfaction, and whether discussing illness displaces prevention topics. Written, self-administered survey of parents at well-child care visits. Two community-based pediatric practices in suburban southeast Michigan. Five hundred parents with children aged 6 months to 12 years. Having a special health care need. Expectations and priorities for discussing illness-related topics (chronic and acute illnesses, medications, specialist referrals, and effects of health on life overall), actual discussion regarding illness and preventive topics, and satisfaction. Compared with parents of children without chronic conditions, parents of CSHCN were more likely to expect to discuss their child's illness (81% vs 92%, respectively; P < .001); 79% of parents of CSHCN ranked illness among their top 3 priorities (vs 53% of other parents [P < .001]). Parents of CSHCN reported discussing a mean of 3.2 illness topics, as compared with a mean of 2.2 illness topics for other parents (P < .001). Having more than 1 unmet expectation for discussing illness was associated with higher odds of lower satisfaction (for parents of CSHCN: odds ratio, 7.2; 95% confidence interval, 2.9-18.3; for other parents: odds ratio, 3.0; 95% confidence interval, 1.7-5.5). Discussing more illness topics was associated with discussing more preventive topics (P < .001). Discussing illness is frequently expected and highly prioritized at well-child care visits, particularly for parents of CSHCN. Unmet expectations are associated with lower satisfaction. Incorporating illness concerns at well-child care visits may improve chronic disease management.

To identify families in which the parents reported the child's illness as particularly stressful (high perception of illness threat), and to find out which health problems the parents perceive as particularly threatening. The parents registered the diagnosis and perception of illness threat in relation to the child's latest illness within a four-week retrospective period. Selected psychosocial conditions of the families were recorded in the same questionnaire. 18,949 families with at least one child under the age of 8 years, resident in the County of Ringkøbing in western Denmark at 1 March 1988. An age-stratified random sample of 1982 families was entered in the study. 85% of the families returned the questionnaire. There was a considerable variation in the parents' perception of illness threat. On the basis of a score it was possible to group parents with a high, medium, and low perception of illness threat. Every fourth family reported a high perception of illness threat. A multivariate analysis, with a high perception of illness threat as dependent and selected psychosocial conditions and the diagnosis as independent variables, led to the following main results: 1) parents with a high perception of the general health threat ("worried" parents) most frequently reported a high perception of illness threat, 2) the diagnoses were decisive; in particular, inflammation in the middle ear, bronchitis, pneumonia, and accidents led to the parents' reporting a high perception of illness threat, 3) parents without experience of children and children's illnesses more frequently perceived an actual illness as a high illness threat than parents with this experience, 4) parents more frequently perceive an illness in girls as a high illness threat. "Worried" parents, without experience of children and children's illnesses, perceive the child's latest illness as a high illness threat. These families need special care.

Clinical Description of Heat Illness in Children, Melbourne, Australia— A Commentary

Short lived acute illness in children is common, yet their parents often feel uncertain about recognising signs symptoms of acute illness and knowing when to seek medical intervention. This has led to seeking unscheduled or delayed support. Digital and mobile technologies are being used to support individuals with healthcare needs, known as digital health interventions. Parents have access to digital health interventions that provide information regarding children’s health, yet there is limited exploration of how these are used to support decision-making when caring for acutely ill children. This systematic review was undertaken to explore digital interventions to support parents with acutely ill children at home. Studies were identified by following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A search of five databases (MEDLINE, CINAHL, Embase, PsycNET, and Web of Knowledge) was conducted using search terms (Medical Subject Headings and keywords) relating to digital interventions, children, acute illness, and health information. Forty-eight papers were screened; seven were included in the review and critically appraised using the Mixed Method Appraisal Tool. In total, 3,558 parents were included. Meta-analysis was not possible due to heterogeneity of papers; thus, narrative synthesis was used to synthesize results and explore relationships between studies. The following aspects were documented: types and characteristics of interventions; how interventions were developed; accessibility, usability and acceptability; measures of impact upon parental knowledge, confidence; and satisfaction with the intervention and usefulness. Limited evidence exists on the availability, impact and efficacy of digital interventions supporting parents caring for acutely ill children at home. Barriers exist regarding accessibility, health literacy and there is limited representation of the diverse needs of parents from different countries, cultures and populations beyond mothers. Further research is needed to co-design and evaluate digital interventions designed with, and for, these parents.