Awareness Of Available Options Research Articles

Factors affecting financing of communal sanitation facilities by the public sector in Informal Settlements: A case of Nyalenda informal settlement, Kisumu City.

To close the current sanitation gap, public funding for sanitation has become increasingly insufficient, particularly in Sub-Saharan Africa. What is concerning in Kenya is not the large number of people who lack access to safe sanitation facilities, but the slow rate at which households can gain access to improved sanitation facilities. A sustainable financing strategy is required, one that will increase resource allocations to the sector, improve the efficiency and effectiveness of existing resources wherever they are found, and tap the potential of alternative financing mechanism. A critical review of policy documents like the County Integrated Development Plan (CIDP) shows that there is hardly any documentation on County sanitation plans. Once sanitation lacks in the CIDP, the county can hardly plan for the sector hence making the residents suffer. The study objectives are to examine different sanitation financing options for communal sanitation facilities in Nyalenda informal settlement, to assess factors affecting financing of communal sanitation facilities by public sector in Nyalenda informal settlement and to establish challenges of financing communal sanitation facilities in Nyalenda informal settlement. The study is a descriptive cross-section design. The study used closed and open-ended questionnaires and key informants’ interview in collection of data where n=400. The study established that the dominant communal sanitation financing option in Nyalenda informal settlement was personal contribution (56.0%), followed by NGO financing (40.3%), while the last was County Government financing (0.5%). Public-private partnerships played a crucial role in facilitating sustainable onsite financing for sanitation facilities as evidenced by majority of the respondents agreeing (35.75%). The study recommended the need for diverse financing sources, awareness of available options, and supportive policies to overcome financial challenges.
 

Attitudes and Barriers to Planned Family Building among Professionals and Trainees in Radiation Oncology

The timing of residency training often coincides with peak biological fertility. However, family building is frequently deferred and may lead to unanticipated infertility. The attitudes and barriers to family planning are not well described among medical professionals and trainees in radiation oncology (RO). The Society for Women in Radiation Oncology (SWRO) conducted an electronic survey among practicing physicians, physicists, and residents between January and February 2023, using email and social media as recruitment tools. The survey questions queried demographics, family planning, fertility. Frequencies of responses were summarized using descriptive statistics. On interim analysis, 147 responses were collected; 123 (89.8%) were SWRO members. Gender identities reported were female (136, 93.2%), male (7, 4.8%), nonbinary or gender diverse (2, 1.4%), and transgender female (1, 0.7%). 95 (64.6%) respondents were age 35 or younger. The majority were practicing physicians (72, 49.0%) followed by RO residents (45, 30.6%), medical physicists (17, 11.6%), medical students, (5, 3.4%), and medical physics residents (4, 2.7%). Most respondents agreed that their reproductive timeline had been impacted by medical training (106, 76.3%). Of those who deferred parenthood due to training or career, 40 (36.7%) were dissatisfied with their choice and 33 (30.2%) were satisfied. 129 (92.8%) reported not receiving any information about fertility preservation during training. Only 65 (47.4%) felt they had a mentor with whom they could approach to discuss family planning. Overall, 84 (60.4%) expressed concern about their fertility and 34 (24.5%) had previously undergone fertility testing. 16 (11.5%) completed at least one cycle of elective fertility preservation and 12 (8.6%) were planning to do so. 39 (28.1%) had considered elective fertility preservation but not pursued it, while 65 (46.8%) had not considered it. Among those two groups, the common reported barriers to accessing fertility services were financial burden (n = 28, 28.6%), lack of awareness of available options (n = 12, 12.2%), difficulty accessing fertility services (n = 6, 6.1%), and difficulty finding time during training (n = 4, 4.1%). Insurance coverage for elective fertility preservation was fully or partially covered by insurance for 12 (8.8%), not covered for 53 (38.7%), and 72 (52.6%) were uncertain of their coverage. The study highlights the impact of training on family building plans of medical professionals in RO. Despite high levels of concern about fertility, few respondents received education about fertility options in training and a limited number had access to mentors to discuss this issue. Significant barriers exist to accessing fertility services, including knowledge gaps about insurance coverage, highlighting a need for further exploration of these barriers and advocacy for improved family planning support for those in RO who desire it.

Carpometacarpal Joint Pathology in the Thumb and Hand: Evaluation and Management of Difficult Conditions.

Thumb carpometacarpal arthroplasty with complete trapeziectomy with or without suspensionplasty, ligament reconstruction, and/or tendon interposition is largely considered equivalent techniques in providing pain relief and improving function for patients with thumb carpometacarpal arthritis. In cases of continued pain, instability, and dysfunction following an index surgery, one must first identify the cause of failure. Any options for revision surgery depend on addressing the specific cause of persistent symptoms with awareness of available options. Most of the patients undergoing revision surgeries can achieve good to fair outcomes.

An overview of Study on Mobile Banking in Bangladesh: Area of Rangpur Division

Several bank in Bangladesh offer their financial services using mobile technology. Mobile transactions are simple and economical for clients. Mobile banking is performing of the finance of the finance related functions on a mobile device such as smartphone or tablet. This paper provides a picture of how mobile banking now operates and what it could look like in the future. The future of the banking industry will get brighter every day as a result of the study’s conclusion that clients are happy with the services provided by the new banking system. This article will significantly benefit Bangladeshi banks by improving service delivery and raising consumer awareness of available options.

Real-world evidence costs of allergic rhinitis and allergy immunotherapy in the commercially insured United States population

Objective To assess total and allergic rhinitis (AR)-related healthcare costs among AR patients residing in the United States with a focus on patients persisting with AIT. Methods AR patients were identified in the IBM MarketScan database between 1 January 2014 to 31 March 2017. Patients receiving allergy immunotherapy (AIT) were identified with relevant billing codes (earliest AIT claim = index date); non-AIT patients were identified with claims containing a diagnosis code for AR (earliest AR claim = index date). AIT patients reaching 25+ injection claims were analyzed as a separate maintenance cohort. All patients were required to have continuous enrollment for 12 months preceding and following index. Results A total of 2,334,530 AR patients were included; 103,207 had at least 1 AIT claim, with 45,279 (43.9%) of these patients reaching maintenance, and 24,640 AIT patients (23.9%) never presenting a single injection claim. Compared to non-AIT patients, patients initiating AIT presented higher rates of baseline comorbidities, including asthma (30.1% vs. 7.5%) and conjunctivitis (21.7% vs. 4.4%). During the follow-up period, patients reaching the maintenance phase of AIT incurred lower total costs than the overall AIT cohort ($10,431±$16,606 vs. $11,612±$24,797), and also presented lower follow-up hospitalization costs ($698±$7,248 vs. $1,281±$12,991) and total medical costs ($7950±$13,844 vs. $8989±$22,019). Conclusions Continued efforts are needed to increase patient awareness of available options and adherence to AIT, along with reducing wastage. Despite AIT patients presenting fairly progressed disease at the time of treatment initiation, this therapy remains an economical treatment option, as it was not accompanied by substantial increases in overall healthcare expenditure, and may promote positive societal impacts beyond the direct medical costs. What is known on this topic The prevalence of allergic diseases has increased over the past 50 years and affects between 10–30% of the world population. Allergic rhinitis (AR) poses a significant economic burden in the form of both direct and indirect costs Allergy immunotherapy (AIT) is the only treatment option able to modify the underlying course of the disease. What this study adds Specific all-cause and AR-related healthcare costs decreased following the initiation of AIT among patients diagnosed with AR, with the largest decreases observed among AIT patients reaching the maintenance phase of treatment, while non-AIT patients showed increases in all categories assessed over a similar follow-up period. Cost decreases among AIT patients were observed despite increased levels of comorbidities compared to non-AIT patients, as the AIT cohort presented elevated rates of atopic dermatitis (7.1% vs. 2.7%), conjunctivitis (21.7% vs. 4.4%), asthma (30.1% vs. 7.5%), and chronic sinusitis (22.6% vs. 4.9%). An analysis of patients’ index subcutaneous AIT consultation revealed substantial variability in the initial treatment costs, with nearly 20% of paid amounts exceeding $1,000; given nearly 1 in 4 AIT patients who get AIT mixed never came back for their first injection, this highlights an opportunity to target frontloaded billing practices and the timing of mixing/injection as an area to minimize healthcare waste.

Engaging Caregivers in Health-Related Housing Decisions for Older Adults With Cognitive Impairment: A Cluster Randomized Trial.

Background and ObjectivesInformal caregivers are rarely as involved as they want to be in the housing decisions of cognitively impaired older adults. Lack of awareness of available options and their benefits and risks may lead to decisions that do not reflect older adults’ preferences, and to guilt and regret. We assessed the effect of training home care teams in interprofessional shared decision-making (SDM) on the proportion of caregivers who report being active in this decision.Research Design and MethodsIn a two-arm pragmatic cluster randomized trial with home care teams working in health centers in the Province of Quebec, we randomized health centers to receive training in interprofessional SDM (intervention) or not (control). Eligible caregivers had made a housing decision for a cognitively impaired adult aged 65 years or older who was receiving services from a home care team. The primary outcome was the proportion of caregivers reporting an active role in decision making. We performed intention-to-treat multilevel analysis.ResultsWe consecutively enrolled a random group of 16 health centers and recruited 309 caregivers, among whom 296 were included in the analysis. In the intervention arm, the proportion of caregivers reporting an active role in decision making increased by 12% (95% CI −2% to 27%; p = .10). After removal of an influential cluster outlier, the proportion increased to 18% (95% CI: 7%–29%; p < .01).Discussion and ImplicationsTraining home care teams in interprofessional SDM increased caregiver involvement in health-related housing decisions for cognitively impaired older adults.

Childcare Instability and Maternal Depressive Symptoms: Exploring New Avenues for Supporting Maternal Mental Health

ObjectiveWe investigated links between childcare experiences—specifically, care instability and mothers' perceptions of care access—and maternal depressive symptoms in an effort to illuminate policy-amenable mechanisms through which childcare experiences can support maternal mental health. MethodsData were taken from the nationally representative Early Childhood Longitudinal Study–Birth Cohort. We used regression models with lagged dependent variables to estimate associations between aspects of childcare instability and perceptions of care availability and maternal depressive symptoms. We did so on the full sample and then on subgroups of mothers for whom childcare instability may be especially distressing: mothers who are low income, working, single, or non-native speakers of English. ResultsChildcare instability—length in months in the longest arrangement and number of arrangements—was not associated with maternal depressive symptoms. However, mothers’ perceptions of having good choices for care were associated with a reduced likelihood of clinical depressive symptoms, even after controlling for prior depressive symptoms and concurrent parenting stress; this latter association was observed both in the full sample (adjusted odds ratio [AOR] = 0.77; 95% confidence interval [CI] = 0.63–0.96) and among subgroups of employed mothers (AOR = 0.71; CI = 0.57–0.87) and single mothers (AOR = 0.72; CI = 0.52–0.99). ConclusionsAlthough dimensions of care instability did not associate with maternal depressive symptoms, mothers’ perceptions of available care options did. If replicated, findings would highlight a previously unconsidered avenue—increasing care accessibility and awareness of available options—for promoting maternal mental health in a population likely to experience depression but unlikely to be treated.

Plans, preferences or going with the flow: An online exploration of women's views and experiences of birth plans

ObjectiveTo explore women’s views of birth plans, and experiences of their completion and use. DesignA qualitative, descriptive study, using Internet-mediated research methods. SettingThe discussion boards of two well-known, UK-based, online parenting forums, where a series of questions relating to birth plans were posted. ParticipantsMembers of the selected parenting forums who had written and used, or who had chosen not to write or use, a birth plan. FindingsWomen responded with a range of views and experiences relating to the completion and use of birth plans. The benefits of birth plans were described in terms of communication with healthcare professionals, potentially enhancing awareness of available options, and maintaining a sense of control during labour and birth. However, many respondents believed the idea of ‘planning’ birth was problematic, and described a reluctance to write a formal plan. The support of healthcare professionals, particularly midwives, was considered essential to the success of both writing and using birth plans. Key conclusionsOur findings show a continued debate among women on the benefits and challenges involved in writing and using birth plans, suggesting problems for a ‘one size fits all’ approach often seen in the use of birth plan templates. In the context of maternity policy supporting women’s choice and personalised care, and as a way of acknowledging perceived problems of ‘planning’ for birth, a flexible approach to birth plans is required, including the consideration of employing alternative nomenclature. Implications for practiceBirth plans remain a point of contention in care contexts around the world. Midwives and other healthcare providers play a central role in supporting women to discuss available options, whether or not they decide to complete a formal birth plan.

Improving Knowledge, Awareness, and Use of Flexible Career Policies Through an Accelerator Intervention at the University of California, Davis, School of Medicine

The challenges of balancing a career and family life disproportionately affect women in academic health sciences and medicine, contributing to their slower career advancement and/or their attrition from academia. In this article, the authors first describe their experiences at the University of California, Davis, School of Medicine developing and implementing an innovative accelerator intervention designed to promote faculty work-life balance by improving knowledge, awareness, and access to comprehensive flexible career policies. They then summarize the results of two faculty surveys--one conducted before the implementation of their intervention and the second conducted one year into their three-year intervention--designed to assess faculty's use and intention to use the flexible career policies, their awareness of available options, barriers to their use of the policies, and their career satisfaction. The authors found that the intervention significantly increased awareness of the policies and attendance at related educational activities, improved attitudes toward the policies, and decreased perceived barriers to use. These results, however, were most pronounced for female faculty and faculty under the age of 50. The authors next discuss areas for future research on faculty use of flexible career policies and offer recommendations for other institutions of higher education--not just those in academic medicine--interested in implementing a similar intervention. They conclude that having flexible career policies alone is not enough to stem the attrition of female faculty. Such policies must be fully integrated into an institution's culture such that faculty are both aware of them and willing to use them.

A public health initiative around advance care conversations and end of life Care

The critical need for family, carer, and community conversations about end of life issues ahs never been more significant. Although most adults would prefer to live their last days at...

Birth Centres and the National Maternity Services Review: response to consumer demand or compromise?

To explore women’s views of birth plans, and experiences of their completion and use.A qualitative, descriptive study, using Internet-mediated research methods.The discussion boards of two well-known, UK-based, online parenting forums, where a series of questions relating to birth plans were posted.Members of the selected parenting forums who had written and used, or who had chosen not to write or use, a birth plan.Women responded with a range of views and experiences relating to the completion and use of birth plans. The benefits of birth plans were described in terms of communication with healthcare professionals, potentially enhancing awareness of available options, and maintaining a sense of control during labour and birth. However, many respondents believed the idea of ‘planning’ birth was problematic, and described a reluctance to write a formal plan. The support of healthcare professionals, particularly midwives, was considered essential to the success of both writing and using birth plans.Our findings show a continued debate among women on the benefits and challenges involved in writing and using birth plans, suggesting problems for a ‘one size fits all’ approach often seen in the use of birth plan templates. In the context of maternity policy supporting women’s choice and personalised care, and as a way of acknowledging perceived problems of ‘planning’ for birth, a flexible approach to birth plans is required, including the consideration of employing alternative nomenclature.Birth plans remain a point of contention in care contexts around the world. Midwives and other healthcare providers play a central role in supporting women to discuss available options, whether or not they decide to complete a formal birth plan.

Levels of engagement and barriers to physical activity in a population of adults with learning disabilities

SummaryThis study examined levels of, and barriers to, physical activity in a population of 19 adults with learning disabilities living in community supported accommodation, using diary records and semi‐structured interviews with staff. The levels of physical activity were higher in the sample population than previous figures for adults with learning disabilities, but lower than figures for the general population. The five main barriers to physical activity identified by staff were: clients’ lack of understanding of the benefits of exercise; client mood; client lack of awareness of available options for physical activity; risk assessment issues and financial constraints.

Digital Hearing Aid Technology: Medical Perspective

This article provides a nontechnical introduction to digital hearing aids and the impact of digital signal processing on the delivery of hearing health care. Issues related to matching the patient's needs to signal processing solutions are covered, and specific recommendations with respect to criteria by which new hearing aid performance should be evaluated are discussed. The pivitol role played by medical personnel in initiating patient awareness of available options and in directing needs assessment is emphasized.