Burden Of Unmet Need Research Articles

Testing Approaches to Mental Health Screening at Prison Entry, Considering Both Concurrent and Predictive Validity in Men and Women

Mental health screening at prison entry is important given the burden of unmet need and the challenge of prioritizing scarce resources, but the evidence to guide approaches to screening is limited. Screening at prison-entry (into prisons or jails receiving people at any stage of the trial or sentencing process) must achieve several aims, from uncovering untreated symptoms to recognizing the need to recommence treatment for established illness, and for a range of mental health conditions. The current exploratory observational study examines different approaches to screening and considers the results of both concurrent (structured diagnostic interview) and predictive (post-screening receipt of prison mental healthcare) methods for validation, in a sample ( n = 291) of men and women entering prison in New South Wales, Australia. A high prevalence of mental health problems, particularly for women was identified across the three screening approaches (i.e., screening for previous psychiatric history, current symptoms, and psychological distress). No single screening approach was superior across validation methods, supporting a broad approach to mental health screening, and differences in validity outcomes were seen between men and women. Prioritizing sensitivity to avoid false-negative cases requires a broad approach to prison-entry mental health screening but a second-stage triage assessment is likely necessary.

Value in care: The contribution of supportive care to value-based lung cancer services-A qualitative semistructured interview study.

Despite significant advances in the management of lung cancer, patients continue to experience a high burden of unmet need impacting quality of life and outcomes of care. Achieving value-based health care, where investment is targeted to services that deliver optimal experience and outcomes of care relative to the cost of delivering that care, requires attention to what people value most in meeting their needs. To date there has been little attention to what matters most to patients with lung cancer (i.e., what they value) as a component of achieving value-based cancer care. This qualitative study was undertaken to investigate components of care valued by people with lung cancer in Australia. This qualitative study used semistructured interviews with 23 people with lung cancer. Participants were recruited using a purposive sampling strategy from two metropolitan tertiary public health services. Data collected included demographic characteristics and patient perspectives regarding their priority concerns and components of care identified as most valuable in meeting their needs. Demographic characteristics of participants were analysed descriptively, and qualitative data were analysed thematically using Interpretive Description. Data analysis generated three key themes: valued components of care; benefits of receiving valued care componentsand consequences of missed opportunities for care. The components of care valued by patients reflect the core dimensions of cancer supportive care, with particular emphasis on ongoing opportunities for consultation (screening for unmet needs) and provision of person-centred information. The facilitation of trust between patients and their treating team, as a consequence of having these valued components evident in their care, was identified as a key characteristic of value-based care. This study has identified valued components of care described by people with lung cancer. Importantly, the care components identified have been proven to improve access to and coordination of care, and demonstrate the importance of integrating supportive care into care provision to achieve value-based cancer care. This study was informed by perspectives of lung cancer patients who participated in semistructured interviews. We acknowledge that this contribution does not meet the criteria for patient and public involvement in research as defined by Health Expectations, but this study forms part of a larger program of cancer supportive care work being undertaken by this team, where comprehensive consumer engagement and co-design approaches are embedded in our work.

Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011-2017.

Hypertension is a major contributor to global morbidity and mortality. In South Africa, the government has employed a whole systems approach to address the growing burden of non-communicable diseases. We used a novel incident care cascade approach to measure changes in the South African health system's ability to manage hypertension between 2011 and 2017. We used data from Waves 1-5 of the National Income Dynamics Study (NIDS) to estimate trends in the hypertension care cascade and unmet treatment need across four successive cohorts with incident hypertension. We used a negative binomial regression to identify factors that may predict higher rates of hypertension control, controlling for socio-demographic and healthcare factors. In 2011, 19.6% (95%CI 14.2, 26.2) of individuals with incident hypertension were diagnosed, 15.4% (95%CI 10.8, 21.4) were on treatment and 7.1% had controlled blood pressure. By 2017, the proportion of individuals with diagnosed incident hypertension had increased to 24.4% (95%CI 15.9, 35.4). Increases in treatment (23.3%, 95%CI 15.0, 34.3) and control (22.1%, 95%CI 14.1, 33.0) were also observed, translating to a decrease in unmet need for hypertension care from 92.9% in 2011 to 77.9% in 2017. Multivariable regression showed that participants with incident hypertension in 2017 were 3.01 (95%CI 1.77, 5.13) times more likely to have a controlled blood pressure compared to those in 2011. Our data show that while substantial improvements in the hypertension care cascade occurred between 2011 and 2017, a large burden of unmet need remains. The greatest losses in the incident hypertension care cascades came before diagnosis. Nevertheless, whole system programming will be needed to sufficiently address significant morbidity and mortality related to having an elevated blood pressure.

Unmet need for presbyopia correction and its associated factors among school teachers in Hawassa city, South Ethiopia

BackgroundPresbyopia is a decline in the amplitude of accommodation with the onset in the age range 40–45 years affecting near visual task performance. As the age of presbyopia onset coincides with productive age, it results in great productivity loss especially in those with high near visual demand like teachers. A maximum near vision potential is essential for teachers in ensuring the quality of education, as most of the students’ evaluations and scripts are assessed manually in Ethiopia. The prevalence of unmet need for presbyopia correction among school teachers ranges from 38.5–70.4% worldwide. Though presbyopia is a common ocular condition, there is limited evidence regarding the unmet need for presbyopia correction in Ethiopia as well as in Hawassa city. Therefore, this study aimed to determine the magnitude of unmet need for presbyopia correction and its associated factors among school teachers in Hawassa city, South Ethiopia.MethodsA school-based cross-sectional study was conducted among teachers older than 35 years. A simple random sampling technique was used to select participants using name lists as a sampling frame from 69 schools. The participants selected underwent for distance and near visual acuity test. Those with distance visual acuity of 6/12 or worse were refracted before near visual acuity test. Information on the spectacle use and associated factors was obtained using the interviewer-administered questionnaire. Data analysis was done using Statistical Package for Social Sciences software version 20. Binary logistic regression analysis was performed to assess association between independent variables and the unmet need for presbyopia correction.ResultsA total of 459 study participants were included in the study with a response rate of 95.21%.The unmet need for presbyopia correction was 51.26% (95%CI: 46.7–55.6%). Female gender (AOR = 2.50; 95%CI: 1.51–4.15), age 36–45 (AOR = 4.12; 95%CI: 1.46–11.76), unaware of presbyopia (AOR = 2.36; 95%CI: 1.2–4.66) and self-rating of current vision as good (AOR = 3.5; 95%CI: 1.61–7.6) were factors significantly associated with the unmet need for presbyopia.ConclusionsThe burden of unmet need for presbyopia correction is a moderate priority according to the World Health Organization for presbyopia correction services criteria. A school-based presbyopia awareness creation program is important to reduce this huge burden.

A Closer Look at Unmet Needs at the End of Primary Treatment for Breast Cancer: A Longitudinal Pilot Study

This study describes the nature of unmet needs (UN) as women with breast cancer transition from “patient” to “survivor.” Data are from a longitudinal study of 90 women with stage I–III breast cancer. Data were collected 2–3 weeks before, and 10 weeks after, completion of radiation. A modified Cancer Survivors’ Unmet Needs (CaSUN) instrument measured UN. Most participants reported ≥1 unmet need at baseline (80.00%) and follow-up (69.31%), with UN across physical, healthcare, information, psychosocial, and survivorship domains. Total number of UN declined over time, t(87) = 3.00, p < .01. UN likely to persist from baseline to follow-up involved cancer recurrence concerns, stress management, household responsibilities, and others not acknowledging/understanding cancer. Younger women (p = .01) and those with more severe (p < .01), life-interfering (p = .01) symptoms had greater burden of UN. This study highlights the dynamics of UN in the weeks before and after primary treatment. Future studies should identify long-term consequences of persistent UN.

Unmet burden of cleft lip and palate in rural Gujarat, India: a population-based study.

The burden of cleft lip and palate (CLP) in the developing world is being tackled by local hospitals and international surgical missions. However, the unmet surgical burden of these conditions is not known, because there are few population-based studies. We conducted this study to find the incidence and prevalence of cleft lip (CL), cleft palate (CP), and CLP and also estimate the unmet burden of these conditions. Four blocks comprising of half a million people in the Patan district of Gujarat were chosen as the study areas. This study was conducted over a period of 3 months in 2009. Patients with CL, CP, and CLP were identified by community health workers using snowball sampling method. Data collected included demographics, type of cleft, operated or not, and place of operation. Disability adjusted life years (DALY) was calculated to measure the unmet burden of this disease. The most common among the three conditions was CL (69.4 %). Overall, cleft abnormalities were more common in males (61 %). The overall incidence and prevalence of cleft deformity was 0.73 per 1,000 live births and 0.1 per 1,000 people respectively. The unmet burden of surgical disease of these four blocks was 230 to 494 DALYs. The incidence of CL with or without palate was found to be 0.7 per 1,000 live births. The large number of unoperated cases (backlog) of cleft deformities suggests a big burden of unmet need in rural India.

Assessment of Morbidity Pattern and its correlates among Elderly Population In Rural area of Perambalur, Tamilnadu, India.

Introduction: In India, both the share and size of elderly population is increasing over time.Unfortunately, the rapidity of population ageing is expected to outpace social and economic development in developing countries particularly in countries like India. Objectives: To study the prevalence of morbidities in elderly aged 60 and above and to find the socio-demographic factors associated with these morbidities. Material and Methods: The present cross sectional study was carried out at the field practice area of Rural Health Centre, at a medical college in South India. The study population comprises of all geriatric population aged 60 years and above in the study area. The survey was done by house to house visit. The study subjects were subjected for personal interview using a pre-tested and semi-structured interview schedule. Statistical analysis is carried out using SPSS Version 17. Results: Most of the elderly people (54.5%) were in 60-64 yr age group. Morbidity was present in 139 (65.2 %) of elderly people. Common morbidity among elderly people were related to oral cavity & salivary glands 129 (69.6%); musculoskeletal system 114 (53.4%); eye & adenexa 85 (39.9%); endocrine, nutritional & metabolic diseases 60 (28.2%); Ear & mastoid process 45 (21.1%) and skin diseases 42 (19.7%). Increasing age and female gender was the two significant risk factors found to be associated with presence morbidity in the present study. Conclusion: Greater, targeted efforts are needed to identify at-risk elderly people living in the community and to provide them with elderly-friendly primary geriatric care services that may reduce the burden of unmet need.

Nationally Representative Household Survey of Surgery and Mortality in Sierra Leone

There is limited evidence to characterize the burden of unmet need of surgical diseases in low- and middle-income countries. The purpose of this study was to determine rate of deaths attributable to a surgical condition and reasons for not seeking surgical care in Sierra Leone. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a survey tool developed collaboratively to be used for cross-sectional data collection of the prevalence of surgical conditions in any country. A population-weighted cluster-sample household survey was conducted throughout Sierra Leone in 2012 using the SOSAS survey tool. Total of 1,840 households (11,870 individuals) were sampled, yielding a 98.3 % response rate. Overall, there were 709 total deaths reported (6.0 %). The mean age at death was 36.4 ± 30.1 years: 330 (46.6 %) were female. Most deaths occurred at home (58.1 % vs. 34.1 % in hospitals). Of the 709 deaths, 237 (33.4 %) were associated with conditions included in our predefined surgical disease category. Abdominal distension/pain was the most commonly associated surgical condition (13.9 %) followed by perinatal bleeding/illness (6.0 %). Among the 237 with surgical conditions, 51 (21.9 %) did not seek medical care, most commonly because of a lack of money (35.3 %) or inability to provide timely care (37.3 %). A large proportion of deaths in Sierra Leone was associated with surgical conditions, the majority of which did not undergo surgical intervention. Our results indicate that to remove barriers to effective surgical care in Sierra Leone policymakers should first focus on relieving financial burdens and increasing access to timely surgical care.

Functional Disability in Elderly Nigerians: Results from the Ibadan Study of Aging

Functional disability is a common reason for loss of independence and need for informal care by elderly persons. There is little information on the profile of disability and the level of unmet need for care in elderly persons living in sub-Saharan Africa. Using a multistage clustered sampling of households conducted in the Yoruba-speaking area of Nigeria (representing 22% of the national population), persons aged 65 and older (N = 2,152) were assessed for disability in activities of daily living and instrumental activities of daily living. Respondents were assessed for self-reports of physical health, for major depressive disorder, and for availability of informal care. The prevalence of any functional disability (defined as inability to independently perform any function) was 9.2% (standard error 0.6). In logistic regression analysis, high risks of disability were associated with female sex, older age, and urban dwelling. Risks were also high for persons with chronic pain, those with poor self-reported overall health, and those with evidence of undernutrition. Disabled persons had poorer quality of life and were more likely to suffer from major depressive disorder; 19.8% of disabled elderly persons lacked any informal care, and this unmet need for care increased the likelihood of having depression. The findings suggest a high burden of unmet need for care in a large section of disabled elderly persons in this African community undergoing demographic and social changes. Social factors relating to urbanization and poverty may be associated with the occurrence of disability and inability to access informal care.

Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being

Large-scale community studies of the prevalence of mental disorders using standardised assessment tools are rare in sub-Saharan Africa. To conduct such a study. Multistage stratified clustered sampling of households in the Yoruba-speaking parts of Nigeria. Face-to-face interviews used the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). Of the 4984 people interviewed (response rate 79.9%), 12.1% had a lifetime rate of at least one DSM-IV disorder and 5.8% had 12-month disorders. Anxiety disorders were the most common (5.7% lifetime, 4.1% 12-month rates) but virtually no generalised anxiety or post-traumatic stress disorder were identified. Of the 23% who had seriously disabling disorders, only about 8% had received treatment in the preceding 12 months. Treatment was mostly provided by general medical practitioners; only a few were treated by alternative practitioners such as traditional healers. The observed low rates seem to reflect demographic and ascertainment factors. There was a large burden of unmet need for care among people with serious disorders.