Chronic Medical Conditions Research Articles

Post-hospitalization remote monitoring for patients with heart failure or chronic obstructive pulmonary disease in an accountable care organization

BackgroundPost-hospitalization remote patient monitoring (RPM) has potential to improve health outcomes for high-risk patients with chronic medical conditions. The purpose of this study is to determine the extent to which RPM for patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) is associated with reductions in post-hospitalization mortality, hospital readmission, and ED visits within an Accountable Care Organization (ACO).MethodsNonrandomized prospective study of patients in an ACO offered enrollment in RPM upon hospital discharge between February 2021 and December 2021. RPM comprised of vital sign monitoring equipment (blood pressure monitor, scale, pulse oximeter), tablet device with symptom tracking software and educational material, and nurse-provided oversight and triage. Expected enrollment was for at least 30-days of monitoring, and outcomes were followed for 6 months following enrollment. The co-primary outcomes were (a) the composite of death, hospital admission, or emergency care visit within 180 days of eligibility, and (b) time to occurrence of this composite. Secondary outcomes were each component individually, the composite of death or hospital admission, and outpatient office visits. Adjusted analyses involved doubly robust estimation to address confounding by indication.ResultsOf 361 patients offered remote monitoring (251 with CHF and 110 with COPD), 140 elected to enroll (106 with CHF and 34 with COPD). The median duration of RPM-enrollment was 54 days (IQR 34–85). Neither the 6-month frequency of the co-primary composite outcome (59% vs 66%, FDR p-value = 0.47) nor the time to this composite (median 29 vs 38 days, FDR p-value = 0.60) differed between the groups, but 6-month mortality was lower in the RPM group (6.4% vs 17%, FDR p-value = 0.02). After adjustment for confounders, RPM enrollment was associated with nonsignificantly decreased odds for the composite outcome (adjusted OR [aOR] 0.68, 99% CI 0.25–1.34, FDR p-value 0.30) and lower 6-month mortality (aOR 0.41, 99% CI 0.00–0.86, FDR p-value 0.20).ConclusionsRPM enrollment may be associated with improved health outcomes, including 6-month mortality, for selected patient populations.

The Impact of COVID-19 Pandemic on Mental Health of Adolescents With Chronic Medical Conditions: Findings From a German Pediatric Outpatient Clinic

PurposeThe impact of the COVID-19 pandemic on the mental health of adolescents is of great concern, especially in the vulnerable group of adolescents with chronic medical conditions. The aim of this study was to examine this impact on the mental health of adolescents with chronic medical conditions treated in a German pediatric outpatient clinic. MethodsChanges in the mental health status of adolescents with chronic medical conditions treated in a German pediatric outpatient clinic during the COVID-19 pandemic were explored via validated screening tools for anxiety and depression. ResultsThe relative risk for adolescents with chronic medical conditions to develop clinically relevant symptoms of anxiety or depression was significantly higher (odds ratio 1,78 [confidence interval 1.06–3.04]) during the pandemic. DiscussionThis study identifies the COVID-19 pandemic as a potential additional risk for adolescents with chronic medical conditions to develop clinically relevant signs of anxiety or depression.

Assessing social functioning and disability: initial exploratory psychometric findings of a promising instrument in adolescents with chronic illness

ABSTRACT Social competence is crucial to functioning in youth with chronic medical conditions. Developmentally sensitive measures of social functioning in this population can aid clinicians in identifying skill deficits and informing treatment interventions that improve social competence. The study explored the psychometric properties of a proposed social functioning measure utilizing data obtained from a clinical sample of chronically ill adolescents enrolled in an evidence-based manualized psychosocial treatment program. Initial exploratory findings support the potential for the SDI to be a valid, reliable, and clinically sensitive measure of adolescent social functioning in teens experiencing functional disability associated with their chronic health conditions.

Whether sodium and fluid restriction reduce exacerbations and readmissions for patients with heart failure: An integrative review

Heart failure (HF) is a chronic medical condition becoming increasingly prevalent around the world. This condition is linked to poor quality of life (QoL) due to the impact it has on patients functional status and mental health. There have been several advancements in the care and management of patients with HF with little change to self-care interventions resulting. Two self-care interventions which are recommended throughout clinical guidelines are sodium and fluid restriction. These are widely used and encouraged through patient education. Research, however, has questioned their validity and demonstrated a lack of evidence on improved outcomes. In order to determine whether changes to current practice is warranted, an integrative review has been completed. The aim is to assess whether these self-care interventions improve outcomes for patients with HF. From this review identified themes include a lack of robust data, the potential harm of interventions, and various outcomes extending beyond HF exacerbations and readmissions. There appears to be a lack of recent data on the impact of a fluid restriction as an independent variable. However, there are noted improvements in a variety of outcomes from both interventions outside of hospital readmissions which demonstrates they are valuable. Given these findings there is not enough evidence to remove restrictions but there are recommendations which can be made to modify current practice. These recommendations include liberalizing sodium and fluid restrictions and making restrictions more specific to the severity of HF for patients going forward.

Experiences and perspectives of integrating nutrition education into an exercise program for people with chronic medical conditions.

Community-based healthy eating and exercise programs are effective interventions to support some people with chronic conditions. This research aimed to explore the experiences and perceptions of participants regarding the integration of nutrition education into a successful group based exercise program for people with chronic medical conditions. Semi-structured interviews were conducted with past participants of a community based group exercise program (Health Moves) with embedded nutrition advice based in a regional area of New South Wales. A total of 60 individuals who had participated in the Health Moves program between 2017 and 2019 were invited to participate and 19 (32%) randomly selected participants consented to be interviewed. Interviews explored participants' experiences, program impacts, and barriers to sustaining changes post program. Similar concepts and patterns were grouped into themes. Four themes were identified that described the experiences with a community-based group exercise intervention with a nutrition component. The major themes evident were that Health Moves facilitated motivation (via access to health professionals, peer support, accountability, affordability); and there were challenges identified to sustaining change (including cost, comorbidities, end of program support, environmental factors); Nutrition advice was valuable for some but not for all (difficulty recalling nutrition components, superficial coverage) Practical and interactive nutrition advice is desired. Participants expressed a high degree of satisfaction with the program but require ongoing support to sustain changes post program. The position and integration of nutrition education within this exercise program was perceived by participants to be suboptimal. Increased access to practical, interactive nutrition education components may improve participant satisfaction and engagement. SO WHAT?: Key findings from this research include a desire for removal of didactic nutrition education sessions and request for increased peer support. Modifications to the program include the integration of interactive self-paced nutrition modules. Peer support partnerships are now encouraged by trainers to support ongoing motivation of participants to keep training together outside the structured exercise program and transition to managing their own exercise routine. Discussions between organisations involved about ongoing pathway/program support or reduced cost 'off peak' gym membership is underway to help with costs incurred by participants.

Food Insecurity, Cardiometabolic Risk and Cardiovascular Disease: A Narrative Review and Call for Action

Food insecurity and insufficient access to affordable nutrition have been associated with increased risk for the development of multiple chronic medical conditions, including cardiovascular disease. In this narrative review, we explore the association between food insecurity and the development of chronic medical conditions that confer increased cardiometabolic risk, cardiovascular disease, and mortality. We also identify the various barriers leading to food insecurity and lack of food literacy, with an emphasis on patients with high blood pressure, diabetes mellitus, stroke, congestive heart failure, and coronary heart disease. We discuss recent developments in legislation and public policies and programs designed to expand our understanding and reduce food insecurity at the local, regional, national, and international levels, and identify opportunities for future research and innovation.

Caregivers' concerns through health professionals' eyes.

Advancements in medicine and science have enabled more and more people to live longer with a chronic medical condition, namely cancer. Nevertheless, the palliative care (PC) approach continues to be introduced and incorporated later in the lives of patients and families dealing with such conditions. Thus, the need for individuals to care for this population in our society is increasing, giving rise to the so-called "informal caregivers." The present study intends to examine the main obstacles faced by informal caregivers taking care of a cancer patient receiving PC based on what health professionals working in these settings perceive and write down. To achieve this goal, the written files of 2 Portuguese palliative care institutions were analyzed. An inductive thematic analysis was conducted, focusing on the contact between health professionals and family caregivers and based on the notes taken by health professionals. Three main overarching themes were identified: (1) burden, (2) intra-family impact of the illness, and (3) network vulnerabilities. Included in this are the emphasis on the role of the family and social support, the high levels of psychological morbidity and caregiver burden present over this period, and a great need for information about the illness. This study provided a broader awareness regarding the daily struggle experienced by family caregivers, particularly those who juggle between "roles." It is vital to understand the scope of the obstacles experienced by caregivers during the terminal phase of their loved one's illness, given how important it is to address the family's needs. Future studies and practitioners should consider these observations and topics when considering new approaches for this population, as they ought to be quite focused and short in time in order to meet people's needs.

Smartphone sensors for evaluating COVID-19 fear in patients with cancer: a prospective study.

This study aimed to analyze the association between the behavior of cancer patients, measured using passively and continuously generated data streams from smartphone sensors (as in digital phenotyping), and perceived fear of COVID-19 and COVID-19 vaccination status. A total of 202 patients with different cancer types and undergoing various treatments completed the COVID-19 Fears Questionnaire for Chronic Medical Conditions, and their vaccination status was evaluated. Patients' behaviors were monitored using a smartphone application that passively and continuously captures high-resolution data from personal smartphone sensors. In all, 107 patients were monitored for at least 2 weeks. The study was conducted between August 2022 and August 2023. Distributions of clinical and demographical parameters between fully vaccinated, partially vaccinated, and unvaccinated patients were compared using the Chi-squared test. The fear of COVID-19 among the groups was compared using the Mann-Whitney and the Kruskal-Wallis criteria. Trajectories of passively generated data were compared as a function of fear of COVID-19 and COVID-19 vaccination status using local polynomial regression. In total, 202 patients were included in the study. Most patients were fully (71%) or partially (13%) vaccinated and 16% of the patients were unvaccinated for COVID-19. Fully vaccinated or unvaccinated patients reported greater fear of COVID-19 than partially vaccinated patients. Fear of COVID-19 was higher in patients being treated with biological therapy. Patients who reported a higher fear of COVID-19 spent more time at home, visited places at shorter distances from home, and visited fewer places of interest (POI). Fully or partially vaccinated patients visited more POI than unvaccinated patients. Local polynomial regression using passively generated smartphone sensor data showed that, although at the beginning of the study, all patients had a similar number of POI, after 1 week, partially vaccinated patients had an increased number of POI, which later remained, on average, around four POI per day. Meanwhile, fully vaccinated or unvaccinated patients had a similar trend of POI and it did not exceed three visits per day during the entire treatment period. The COVID-19 pandemic continues to have an impact on the behavior of cancer patients even after the termination of the global pandemic. A higher perceived fear of COVID-19 was associated with less movement, more time spent at home, less time spent outside of home, and a lower number of visited places. Unvaccinated patients visited fewer places and were moving less overall during a 14-week follow-up as compared to vaccinated patients.

Voices of the unhoused from Santa Fe, New Mexico: A mixed methods study of health status, substance use, and community harm reduction program perspectives

No published studies have examined the community service priorities and harm reduction perspectives of unhoused people in Santa Fe, New Mexico. We conducted a mixed methods pilot study of 56 unhoused people at community locations in Santa Fe to: (1) assess the current prevalence of chronic medical conditions and substance use; (2) highlight community service priorities; and (3) explore views of innovative community harm reduction programs. Our first hypothesis was there would be high prevalence of chronic medical conditions, for which we found high prevalence of post-traumatic stress disorder, major depression, substance use disorders, chronic pain, and hypertension. Our second hypothesis was that we would find top community service priorities of housing, food, and health care. We found long- and short-term housing and food, but not healthcare, top priorities. Our third hypothesis was that we would find mixed support for community harm reduction initiatives like managed alcohol programs and overdose prevention centers. We found positive, not mixed, support for these community harm reduction programs among Santa Fe’s unhoused. Unhoused study participants ranged in age 27–77 years, with lifetime years unhoused from less than one year to 63 years. Study limitations included small sample size, convenience sampling, and descriptive results. Policies and program initiatives supporting additional Housing First options, managed alcohol programs, and overdose prevention centers in the Santa Fe community are clearly indicated to increase engagement with this vulnerable population. Future research should focus on inclusion of the perspectives of the unhoused in the design, conduct, evaluation, and dissemination of community programs to meet the needs of the unhoused, with re-defined outcomes to include changes in quality of life, program engagement, demarginalization, and future goals and plans, beyond currently utilized health and social service program outcome measures.

Rates of Lower Respiratory Tract Illness in US Adults by Age and Comorbidity Profile.

While it is widely recognized that older adults, adults with chronic medical conditions (CMC), and adults with immunocompromising conditions (IC) are at increased risk of lower respiratory tract illness (LRTI), evidence of the magnitude of increased risk is limited. This study was thus undertaken to characterize rates of hospitalized and ambulatory LRTI among United States (US) adults by age and comorbidity profile. A retrospective cohort design and US healthcare claims database (2016-2019) were employed. Study population included adults aged≥18years and was stratified by age and comorbidity profile (CMC-, CMC+, IC). LRTI was ascertained overall and by pathogen pathogen (e.g., respiratory syncytial virus [RSV]), and was classified by care setting (hospital, emergency department [ED], physician office/hospital outpatient [PO/HO]). Relative rates (RR) of LRTI generally increased with older age across care settings (vs. 18-49years), with the most marked increase for hospitalizations: for LRTI-hospitalized, RRs ranged from 3.3 for 50-64years to 46.6 for≥85years; for LRTI-ED and LRTI-PO/HO, RRs ranged from 1.0 to 2.7 and from 1.3 to 1.5, respectively. Within age groups, LRTI rates were also consistently higher among CMC+and IC adults (vs. CMC- adults). Age-specific RRs of LRTI patients hospitalized due to RSV were largely comparable to overall LRTI; age-specific RRs for other care settings, and RRs for CMC+and IC adults (vs. CMC- adults), were generally higher for LRTI due to RSV. Incidence of LRTI, including that due to RSV, especially for events requiring acute inpatient care, is markedly higher among older adults and adults of all ages with CMC or IC.

A survey of Australian public opinion on using comorbidity to triage intensive care patients in a pandemic.

Objectives This study aimed to determine which method to triage intensive care patients using chronic comorbidity in a pandemic was perceived to be the fairest by the general public. Secondary objectives were to determine whether the public perceived it fair to provide preferential intensive care triage to vulnerable or disadvantaged people, and frontline healthcare workers. Methods A postal survey of 2000 registered voters randomly selected from the Australian Electoral Commission electoral roll was performed. The main outcome measures were respondents' fairness rating of four hypothetical intensive care triage methods that assess comorbidity (chronic medical conditions, long-term survival, function and frailty); and respondents' fairness rating of providing preferential triage to vulnerable or disadvantaged people, and frontline healthcare workers. Results The proportion of respondents who considered it fair to triage based on chronic medical conditions, long-term survival, function and frailty, was 52.1, 56.1, 65.0 and 62.4%, respectively. The proportion of respondents who considered it unfair to triage based on these four comorbidities was 31.9, 30.9, 23.8 and 23.2%, respectively. More respondents considered it unfair to preferentially triage vulnerable or disadvantaged people, than fair (41.8% versus 21.2%). More respondents considered it fair to preferentially triage frontline healthcare workers, than unfair (44.2% versus 30.0%). Conclusion Respondents in this survey perceived all four hypothetical methods to triage intensive care patients based on comorbidity in a pandemic disaster to be fair. However, the sizable minority who consider this to be unfair indicates that these triage methods could encounter significant opposition if they were to be enacted in health policy.

Improving transition of care from pediatric to adult endocrinology for adolescents with diabetes

IntroductionAdolescence is a challenging time in a child’s life and can be even more stressful for those with a chronic medical condition such as diabetes mellitus. Adolescents and young adults with type 1 and type 2 diabetes experience worsening glycemic levels as they enter adulthood. Data suggest that a formalized health care transition process and beginning transition preparation in early adolescence leads to better transition outcomes. MethodsThe aim of this study was to create a transition of care program for youth with diabetes in a standalone children’s hospital by following the Got Transition Six Core Elements of Health Care Transition. First, we implemented a transition of care policy and formalized how we discussed transition of care with patients and families in early adolescence. Further improvements have included assessing readiness to transition, designing a curriculum centered around adolescent-specific issues and how they relate to diabetes management, and forming connections with adult endocrinologists in the area to establish a seamless transition process. ResultsAfter implementing our program, 90 % (28/31) of our patients indicated they were very or somewhat ready to transition to adult care. DiscussionWe outline our process for developing a transition of care program and provide a practical tool for other pediatric diabetes providers who are interested in implementing a similar program.

An Assessment of Pharmaceutical Care Rendered by Community Pharmacists to Type 2 Diabetes Mellitus Patients in South-West Nigeria

Background: Diabetes mellitus is a chronic medical condition that requires a life-long management. Community pharmacists render pharmaceutical care services that help in the resolution of medication related problems associated with chronic diseases thereby improving the quality of life of patients. Objectives: This study focused on assessing pharmaceutical care services rendered to type 2 Diabetes Mellitus (T2DM) by community pharmacists in Osun State, Nigeria. Method: Thirty-five (35) community pharmacists in major towns in Osun State, South-west, Nigeria were sampled using convenient sampling technique. ‘Secondary’ mystery patient (undercover patient relative) consultation was made with the community pharmacists in their pharmacies. The consultation involved the use of prescription form that had intentional drug therapy problems and complaints of oedema. Some of the services assessed included availability of point of care tests, prescription screening and patient education and counselling. Field notes were taken after each consultation with the pharmacists. Results: A little above one-third (37.0%) of the community pharmacists check blood glucose for T2DM patients. Some (23) of the pharmacists highlighted the need for the patient to come in-person or report to a physician citing the complaint (oedema) as an indication of possible complication(s). Five pharmacists identified the overdose of metformin and Glibenclamide in the prescription. Six pharmacists flagged possible drug-drug interaction between metformin and cimetidine. Majority (34) of the pharmacists counsel patients and provide patient education on T2DM. Conclusion: Community pharmacists in Osun State counsel T2DM patients and provide patients education. Few of them screen prescriptions and provide point of care test.

The experience of people living with heart failure in Ethiopia: A qualitative descriptive study.

Heart failure is a serious chronic medical condition that negatively impacts daily living. Living with heart failure can be challenging due to the physical symptoms, unpredictable nature of the disease, and lifestyle changes required. The objective of this study was to explore and describe the experiences of people living with heart failure and how it affects their health-related quality of life in Ethiopia. A qualitative descriptive design was employed to explore the experience of people living with heart failure, guided by the Theory of Symptom Management. A purposive sample of 14 participants was recruited from the cardiac outpatient clinics at two tertiary-level public hospitals in Ethiopia. Data were collected using a semi-structured interview. The recorded interviews were transcribed verbatim in Amharic, translated into English, and entered NVivo statistical software for analysis. An inductive-deductive hybrid thematic analysis method was used to analyse the data. Three themes were identified deductively, while an additional three themes emerged inductively:-"Journey from diagnosis to daily life with heart failure"; "Symptom experience"; "Impact of heart failure on health-related quality of life"; "Perception of health-related quality of life and influencing factors"; "Symptom management and coping strategies"; and "Challenges faced in the journey of living with heart failure". Fatigue, and depression were the most frequently reported symptoms. Participants described how their condition affected their overall physical functioning. Participants utilized consistent follow up-care, adhered to their medications, ensured adequate rest, made dietary modifications, sought social support and engaged in spiritual activities to manage their symptoms and cope with their condition. Challenges they faced included financial difficulties, unavailability of medications, and a lack of continuity of care. People living with heart failure in Ethiopia experience various symptoms. The impact of heart failure on various aspects of their lives, combined with the challenges they face while living with heart failure, significantly affect their health-related quality of life. Health care providers caring for these people need to understand their experiences and the impact on their daily life. Effective multimodal interventions are needed to reduce the impact of heart failure and improve health-related quality of life in this population.

Health-care Utilisation among Elderly People with Chronic Medical Conditions in a Secondary Health-care Center, Southwestern Nigeria

Abstract Background: The elderly population of the world is projected to continue to increase. There is an anticipated increase in the utilisation of health-care services due to chronic diseases and other impairments with resulting pressure on health systems. Aims: This study aimed to determine the health-care utilisation of elderly patients with chronic medical diseases attending a secondary health facility in southwestern Nigeria. Materials and Methods A structured questionnaire was administered to gather the data from 300 older people by random sampling during follow-up care for those receiving care for more than 6 months following a diagnosis of a chronic disease. SPSS software version 26 was used for the data analysis, and the results are presented in the tables. The Chi-square test was applied to test for associations between the categorical variables, and a logistic regression model was used to rule out confounders, while P < 0.05 was considered to indicate statistical significance. Results: The mean age (standard deviation) in the study was 68.26 (7.01) years and 58.3% were females. The average number of routine clinic visits was 4.12, whereas 20.7% had emergency room visits, 6.6% were referred to specialists, and 33.3% had laboratory investigations. After logistic regression was applied, living conditions, average monthly income, and treatment for diabetes were found to be significant factors for the utilisation of care. Conclusion: The provision of rich social support, improving economic empowerment, and performing screening and timely management for diabetes will improve preventive care while reducing the use of expensive and specialised care for older people.

CLINICO-DEMOGRAPHIC CORRELATES OF COGNITIVE IMPAIRMENT AMONG THE OLDER ADULTS IN SELECTED SPECIALTY CLINICS IN MAIDUGURI, NIGERIA.

Background: Older adults with chronic medical conditions have a high prevalence of cognitive impairment, which may be linked to the chronicity of their illnesses. This study aimed to identify demographic and clinical factors associated with cognitive impairment in older adults with chronic medical conditions attending specialty clinics in Maiduguri. Methods: A cross-sectional analytical study was conducted involving older adults aged 60 years and above, utilizing a consecutive sampling approach over a period of six months. Participants completed the sociodemographic questionnaire, clinical proforma and assessment using Community Screening Instrument for Dementia (CSID). Data analysis was performed using SPSS version 26.0, with significance level set at 0.05. Non-parametric tests were employed to compare continuous dependent variables that were not normally distributed across different groups of independent variables. Results: The mean age (±SD) of the respondents was 66.6 (±5.5) years. The prevalence of cognitive impairment was 14.7%. It was higher among the 70-79 age group, the widowed, and those with no formal education. There was a significant association of cognitive impairment with the medical conditions (p = 0.001). It was worst among those with hypertension-diabetes comorbidity, those with the longest duration for ≥21 years, those using ≥5 medications, and those with 3-4 previous admissions. Conclusion: The present findings hold significance for the healthcare of older adults, as they can enhance clinical procedures by raising awareness regarding cognitive impairment. Additionally, these findings may contribute to the establishment of a comprehensive approach to their care, bridging the gap between psychiatric and medical practices.

Older Veteran Experiences of using Technology during a Multicomponent Telerehabilitation Program: A Convergent Mixed Methods Study.

Less than half of U.S. veterans meet physical activity guidelines. Even though changing physical activity can be challenging, prior studies have demonstrated that it is possible. Older adults are using technology to aid in such behavior change. However, research that explores the mechanisms of how technology can aid in behavior change is lacking, especially among older veterans. Thus, the purpose of this secondary, convergent mixed methods study was to explore how older veterans engaged with technologies that were used during a multicomponent telerehabilitation program. The study included veterans aged ≥60 years with ≥3 chronic medical conditions and physical function limitation. Quantitative data were collected during the primary randomized controlled trial, and qualitative data were collected via individual interviews following completion of the telerehabilitation program. Data were merged and then analyzed by high vs. low technology engagement groups. Key similarities and differences between groups were identified in five domains: satisfaction with the virtual environment, coping self-efficacy, perceptions of Annie (automated text messaging platform), experiences using the activity monitor, and self-management skills. Findings can help inform the successful integration of similar technologies into physical rehabilitation programs. Further study is warranted to understand additional factors and mechanisms that influence technology engagement in telerehabilitation.

Prevalence and predictors of depression and anxiety among workers at two points of entry in Botswana during the COVID-19 pandemic.

points of entry (POE) staff are particularly prone to depression and anxiety during outbreaks. The study aimed to determine the prevalence and predictors of depression and anxiety among POE staff in Botswana. this was a cross sectional study at Sir Seretse Khama International Airport (SSKIA) and Tlokweng border from 02/12/2021 to 24/02/2022 during the COVID-19 outbreak. The Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 item scale (GAD-7) were used to screen for depression and anxiety respectively. Logistic regression was used to determine predictors of depression (PHQ-9≥10) and anxiety (GAD-7 ≥10). a total of 276 POE workers participated in the study of which 60 (21.7%) had an abnormal PHQ-9 score (had depression). Anxiety levels were abnormal in 31 (11.2%) participants. The predictors of depression were working at SSKIA (Adjusted odds ratio (AOR) 0.22, 95% Confidence interval (CI) 0.08-0.65), age >39 years (AOR 0.15, 95% CI 0.03-0.68), having a diploma (AOR 0.27, 95% CI 0.008-0.89), having a degree or higher (AOR 0.23, 95% CI 0.07-0.80), history of asthma (AOR 4.43, 95% CI 1.17-16.72), experience of stigma and discrimination (AOR 2.93, 95% CI 1.01-8.55) and having older people (>65 years) in the household (AOR 4.61, 95% CI 1.64-12.99). The predictors of anxiety were having chronic medical conditions (AOR 5.76, 95% CI 1.34-24.78) and experience of stigma and discrimination (AOR 6.82, 95% CI 1.42-32.46). depression and anxiety were detected in a significant number of participants. Multiple risk factors were identified. Public health interventions should target these risk factors.

Nurses’ Perception on the Hindrances of Triage System in Emergency Unit

Background: Despite the fact that several triage tools have been implemented globally, emergency care, including the triage system, is often one of the weakest parts of the health system in developing countries, as compared to developed countries. Moreover, emergency centers in African countries are very busy, often flooded by high load of trauma patients, chronic medical conditions, acute medical emergencies, and HIV‐related conditions. These disease conditions precipitate the reasons for the prioritization of patients. In South Africa, studies conducted on the use of triage by nurses revealed that most patients are satisfied with the Nurse‐led triage service provided in emergency departments (EDs). At the same time, some Nurses also see the South African Triage Scale (SATS) as one of the easiest Nurse‐led triage tools.Aim: The study aimed at identifying the factors hindering the effective process of triage during care provision at a selected public hospital in KwaZulu‐Natal (KZN).Methods: This study utilized a cross‐sectional survey, employing a nonprobability convenience sampling to recruit its respondents. The recognition primed decision model formed the framework of the study. Ethical clearance was obtained from the University of KwaZulu‐Natal Ethics Review Board, and ethics principles were carefully observed throughout the study.Results: Out of the 100 respondents, 89% (89) of the respondents perceived that various factors still impede the progress of triage, while 11% (11) of the respondents perceived that no factor impedes the progress of triage.Conclusion: The study indicates that several factors still hinder the effective process of triage. Based on the findings of the study, factors like overcrowding, Nurses waiting for doctors when they know what to do, lack of continuous professional development on triage system, inadequate experience, lack of confidence, and lack of adequate training on triage still impede the efficient triage system.

Exploring the psychological impact of anxiety, depression, and quality of life in patients with comorbid disease conditions post COVID-19 pandemic era

BackgroundChronic diseases and comorbidity are important predictors of depression and anxiety, the two most common disorders of poor mental health. Meanwhile, the pandemic increases anxiety and depression levels, alongside declined quality of life (QoL), the same way that comorbidities are associated with severity of COVID-19 progression. This study aimed to assess the prevalence of anxiety and depression, as well as the QoL among patients with chronic medical conditions in Amman, Jordan, in the post-pandemic period. MethodsA descriptive, cross-sectional study was conducted among patients with comorbidities using a validated questionnaire consisting of 3 parts. Anxiety and depression prevalence were assessed using the Hospital Anxiety and Depression Scale (HADS), while the QoL in terms of physical, psychological, social, emotional, and general mental health was evaluated using the SF-36 QoL questionnaire. ResultsA total of 150 participants (mean age=55±13 years) were enrolled in the study. Most participants reported a significantly elevated level of borderline abnormal or mild anxiety (44%, P<.0001). The QoL scores indicated relatively poor well-being, particularly in the physical role (29.2±45.5) and emotional role (26.2±4.0) domains (P<.05). Statistical significance was observed between HADS anxiety or depression scores and variables, such as age, education level, and comorbidities. ConclusionThis study's findings provide insights into the adverse psychiatric consequences, high prevalence of anxiety and depressive symptoms, and reduced quality of life among patients with comorbid conditions post-COVID-19 pandemic.