Formal Health Research Articles

Mental Health Issues for Frontline Hospital Staff During Height of Covid Pandemic 2020

AbstractIntroductionWhen the SARS-Cov2 virus hit the New York and New Jersey metropolitan area in Spring 2020, hospitals and hospital workers were hit hard with a new unknown pathogen that either killed people or made them very ill. There were large numbers of severely ill patients that strained resources. Hospital workers had extraordinary stress with multiple additional patients, the need to use personal protective equipment (PPE) in short supply, and faced with a pathogen that had no treatments beyond care and support initially.MethodsWe surveyed our hospital workers in late Spring 2020 to identify the main stressors and find out what measures were helpful. An online anonymous survey included questionnaires about sleep, mood, outside stressors, helpful measures, and how they coped generally. All levels of hospital workers were surveyed. Resources were provided to all respondents.ResultsOver 240 individuals responded to the survey; most respondents were women (76%). ‘Workplace stressors’ topped the chart for 98 of our respondents. The worst workplace stressor that was cited was ‘irritable workforce,’ but ‘lack of ‘protocols’ and ‘shortage of PPE’ were also cited as stressors. ‘Other’ (not described) and ‘taking care of an ill relative’ were rated highly. Those who had ‘symptoms everyday:’ Anhedonia (loss of pleasure or interest), 13%; feeling down and hopeless, 12%; sleep disturbance, 41%; low energy, feeling tired, 29%; appetite disturbance, 26%; poor concentration and attention, 15%. Respondents told us what resources they used and what was most helpful; exercise was most frequently cited as helpful.Lessons Learned and DiscussionVarious resources for formal and informal mental health support were provided to all respondents at the time of survey. Our hospital mounted its own response with support services, as did our medical school and university. A "warm line" was available through the Department of Psychiatry from late March 2020; tip sheets and online groups were widely circulated; State Department of Health provided resources. There were formal peer support sessions and workers helped each other. Medical students provided child care, shopping, and transport. We learned that extra support for workers and more frequent rest and recharge time are important. A weekly "town hall" was instituted and a weekly update about the hospital and support in healthy activities are widely circulated to employees. Those with active PTSD (some were very disturbed by the number of deceased patients) were referred to professional providers. Hospitals need to be ready to deal with epidemics and pandemics more effectively in order to mitigate stress and support workers. Being prepared, not just with equipment, but with protocols in how to proceed should another pandemic come. We learned that listening to workers is important. Workers also need to know how valued they are.FundingDepartment of Psychiatry, New Jersey Medical School

"You could find a good or a bad provider, I would say you just have to go and see": A qualitative study of the influence of perceptions of service quality on family planning service use in Burkina Faso.

This qualitative study from Burkina Faso explores community-level perceptions of family planning (FP) service quality among FP users and non-users. It examines how perspectives on service quality may influence women's motivation to seek modern methods from health facilities. For this study, twenty focus group discussions were undertaken with non-users and current users of modern FP including unmarried, sexually active women ages 15-19 and 20-24 and ever married women ages 15-24 and 25+ in Bobo Dioulasso and Banfora, Burkina Faso. The findings demonstrate that respondents prioritized a welcoming environment, positive provider-client exchanges, the full provision of information (especially about side-effects), a pain-free experience, a short waiting time, and privacy and confidentiality. Poor service quality did not, in general, reduce women's demand or need to use a FP method. Some women who were reluctant to use formal health services used a non-facility-based method (calendar method, withdrawal, condoms or abstinence). Importantly, many unmarried, younger women and adolescents, who were more likely to be stigmatized by providers, exhibited agency by proactively seeking a method despite the potential for a negative experience. They prioritized their health and wellbeing over and above any interpersonal barriers they were likely to encounter. Incorporating strategies to improve the quality of FP services based on locally defined elements of quality should be a specific programmatic goal. These strategies can be identified through quality assessments employing a woman-centered lens. Women who visit facilities can be encouraged to share their positive experiences with their networks to improve community-level perspectives of facility quality. Improving service quality can attract new users, especially adolescents, and retain those who have already adopted a FP method. Through these multi-pronged actions, women's (and community) expectations and experience of quality can improve. This, in turn, may lead to greater client satisfaction and associated higher FP prevalence.

Determinants of Rural Women’ Healthcare Behavior in Khyber Pakhtunkhwa, Pakistan

Current study has examined the determinants of healthcare seeking behaviour of rural women in Khyber Pakhtunkhwa province of Pakistan. For this, data were collected from 178 respondents using a questionnaire and key informants interviews i.e. lady health workers (10) and doctors (10). For data analysis, descriptive statistics and thematic analysis were used. It was found that majority of the respondents did not sought immediate healthcare. Various themes have been identified through thematic analysis such as social, cultural and economic factors which influence healthcare seeking behavior of rural women in the study area. Social factors included gender and patriarchy, while restricted mobility, low educational status, and non-preference of women healthcare needs were encompassed by cultural factors. Economic factors comprised of affordability and availability of transportation. Therefore, appropriate and long term planning and execution from the formal health care system of the province in the light of current study findings are suggested.

Help-Seeking and Barriers to Service Use amongst Men with Past-Year Suicidal Ideation and not in Contact with Mental Health Services

Objective Men are less likely than women to engage with formal mental health services for suicidality. We describe the sources of support, barriers to service use, and coping strategies of men with past-year suicidal ideation who are not receiving formal mental health services. Method Australian men experiencing past-year suicidal ideation who also did not receive formal mental health services within the past year (n = 176) completed a survey that assessed help-seeking behaviors, coping strategies and styles, use of general services, barriers to service use, and individual-level characteristics. Analyses included descriptive statistics and bivariate analyses. Results The most common type of support was self-help resources, and self-reliance was the most common barrier to formal mental health service use. Most participants had seen a GP for non-mental-health-related reasons in the past year. Men who did not seek any help for their suicidality experienced lower instrumental barriers and perceived need for support, and lower levels of certain coping styles. Limitations included a cross-sectional design and small sample size. Conclusion The current study provides insight into the help-seeking experiences of men with past-year suicidality and not receiving formal mental health services. The findings suggest it may be helpful to improve the linkage between online and informal sources of support and evidence-based interventions. HIGHLIGHTS Online self-help, friends, and partners were the most commonly used sources of help. A subset of men (42%) with lower perceived need for help did not seek any support. Despite no past-year formal mental health service use, 80% of the men had seen a GP.

Health Systems Need to Transform Data Collection to Advance Health Equity.

Health Systems Need to Transform Data Collection to Advance Health Equity.

Psychological distress, non-medical use of prescription medications, and perceived unmet mental health care needs: a cross-sectional study of Ontario students.

The non-medical use of prescription medications among adolescents has become a concerning public health issue. This study assessed the prevalence of the non-medical use of prescription medications in Ontario high school students, and explored the moderating effect of this use on the relationship between psychological distress and unmet mental health needs. Cross-sectional data for 4896 students, age 14-18, were drawn from the 2019 Ontario Student Drug Use and Health Survey. Psychological distress was measured using the Kessler-6 Distress Scale, unmet mental health needs were defined by self-report (yes/no), and non-prescription medication use was defined by self-reported frequency of use. Using logistic regression, we explored the effect of the non-medical use of prescription medications on the relationship between psychological distress and unmet mental health needs. High proportions of Ontario students reported serious psychological distress (22%), some degree of unmet mental health need (38%), and/or non-medical use of prescription medications (13%). While there were strong associations between psychological distress and unmet mental health need, this association was weaker among those reporting non-medical use of prescription medications (OR = 3.3, 95% CI 1.9-5.7) compared to non-users (OR = 5.6, 95% CI 4.5-7.1). Our findings suggest that Ontario students experiencing distress and using non-prescribed medications are less likely to identify a need for mental health support, highlighting the consequences of apparent self-medication through misuse of prescription medications. To assist in the redirection of adolescent perceptions of healthy coping strategies, population-based educational programming, with targeted promotion of both formal and informal mental health care resources, should be considered.

Local health department engagement with workplaces during the COVID-19 pandemic-Examining barriers of and facilitators to outbreak investigation and mitigation.

To document local health department (LHD) COVID-19 prevention or mitigation activities at workplaces in the United States and identify facilitators for and barriers to these efforts. We conducted a web-based, cross-sectional national probability survey of United States LHDs (n = 181 unweighted; n = 2,284 weighted) from January to March 2022, collecting information about worker complaints, surveillance, investigations, relationships and interactions with employers/businesses, and LHD capacity. Overall, 94% LHD respondents reported investigating workplace-linked COVID-19 cases; however, 47% reported insufficient capacity to effectively receive, investigate and respond to COVID-19-related workplace safety complaints. Prior relationships with jurisdiction employers and LHD personnel with formal occupational health and safety (OHS) training were predictors of proactive outreach to prevent COVID-19 spread in workplaces (p < 0.01 and p < 0.001). LHD size predicted OHS personnel and sufficient financial resources to support workplace investigation and mitigation activities (p < 0.001). Differences in LHD capacity to effectively respond to communicable disease spread in workplaces may exacerbate health disparities, especially between rural and urban settings. Improving LHD OHS capacity, especially in smaller jurisdictions, could facilitate effective prevention and mitigation of workplace communicable disease spread.

Formal health care costs among older people in Ireland: methods and estimates using The Irish Longitudinal Study on Ageing (TILDA).

Background: Reliable data on health care costs in Ireland are essential to support planning and evaluation of services. New unit costs and high-quality utilisation data offer the opportunity to estimate individual-level costs for research and policy. Methods: Our main dataset was The Irish Longitudinal Study on Ageing (TILDA). We used participant interviews with those aged 55+ years in Wave 5 (2018) and all end-of-life interviews (EOLI) to February 2020. We weighted observations by age, sex and last year of life at the population level. We estimated total formal health care costs by combining reported usage in TILDA with unit costs (non-acute care) and public payer reimbursement data (acute hospital admissions, medications). All costs were adjusted for inflation to 2022, the year of analysis. We examined distribution of estimates across the population, and the composition of costs across categories of care, using descriptive statistics. We identified factors associated with total costs using generalised linear models. Results: There were 5,105 Wave 5 observations, equivalent at the population level to 1,207,660 people aged 55+ years and not in the last year of life, and 763 EOLI observations, equivalent to 28,466 people aged 55+ years in the last year of life. Mean formal health care costs in the weighted sample were EUR 8,053; EUR 6,624 not in the last year of life and EUR 68,654 in the last year of life. Overall, 90% of health care costs were accounted for by 20% of users. Multiple functional limitations and proximity to death were the largest predictors of costs. Other factors that were associated with outcome included educational attainment, entitlements to subsidised care and serious chronic diseases. Conclusions: Understanding the patterns of costs, and the factors associated with very high costs for some individuals, can inform efforts to improve patient experiences and optimise resource allocation.

Mental Health Services Use and Social Support Among Latinx Families with Adolescents Who Engage in Suicidal Behavior

ABSTRACT Latinx communities experience a significant child mental health disparity. Research is needed to examine mental health services use and social support in Latinx adolescents, with particular attention to acculturative factors and youth who have high levels of clinical severity. The current study examined whether acculturation and enculturation, and related proxies, are associated with prior history of services use and social support in Latinx families with adolescents who had a recent suicidal crisis. Participants were 110 youths, recently admitted to psychiatric hospitalization, ages 12–17 years and their caregivers. Results indicated that approximately 20% of the overall sample did not access any formal mental health services (e.g. outpatient mental health care, primary care support, school staff support) before high acuity hospital care. First-generation status and higher caregiver enculturation were associated with a lower likelihood of formal mental health services use, even when controlling for clinical covariates. Adolescent preference for Spanish was associated with lower social support. Findings suggest that families with higher enculturation and first-generation immigrant families (both caregivers and youth born outside of the U.S.), in the context of severe clinical impairment, experience systemic and sociocultural barriers conducive to limited engagement with mental health support. Implications for improving the accessibility of mental health supports are reviewed.

Meningkatkan Kesadaran Pentingnya Pendidikan dan Kesehatan pada Anak-Anak Suku Kokoda

This service aims to increase the awareness of the children of the Kokoda Tribe in Warmon Village about the importance of formal education and health. The methods used are counseling and demonstrations. Counseling was carried out to provide awareness and motivation to the children of the Kokoda tribe, while demonstrations were conducted to provide examples and direct practice on how to wash hands and brush their teeth properly and correctly. In addition to counseling and demonstrations, in this service activity, gifts in the form of stationery and personal hygiene kits were also distributed to the children of the Kokoda Tribe, Warmon Village. After the dedication, it was seen that the children of the Kokoda Tribe in Warmon Village became motivated and enthusiastic and were diligent in going to school.

Perspectives of people with Parkinson's disease and family carers about disease management in community settings: Across-country qualitative study.

To explore perceptions of people with Parkinson's disease and family carers about the use and impact of health and social care services, community and voluntary sector resources for the management of Parkinson's disease. Resources from outside the formal health care system and collaborations between different levels and sectors could address the unmet needs of people with Parkinson's disease and their family carers and improve the management of Parkinson's disease in the community setting. A qualitative exploratory study was carried out in Denmark, Norway, Spain and the United Kingdom and was reported using the COREQ. Individual semi-structured interviews were conducted with people with Parkinson's disease and family carers between May and August 2020. Interviews were digitally recorded, transcribed verbatim and analysed using thematic analysis. A meta-ethnographic approach was used to analyse and synthesise cross-national findings. Forty-seven people with Parkinson's disease and 39 family carers participated in the four countries. Four themes and eight sub-themes emerged: (1) Personalised care for needs throughout the Parkinson's disease journey; (2) Accessibility of different types of support systems (including initiatives to support emotional well-being, physical rehabilitation, information on the healthcare services, voluntary associations and community groups); (3) Multiagency collaborations, a more comprehensive approach; (4) Acknowledgment of people with Parkinson's and family carers own role in Parkinson's disease management. An integrated and person-and-community-centred approach, which includes the participation of the health, social, voluntary and community sectors, is desired by people with Parkinson's disease and their family carers to improve the management of Parkinson's in the community setting. These findings could contribute to the creation of more sustainable care systems at the European level that would better respond to individual and changing needs in people with Parkinson's disease and their family carers, and in other long-term conditions. The Patient and Public Involvement groups contributed to the design of the study, the interview guides and validation of findings. This study will inform the management of Parkinson's disease at the community level and the use of resources not only directly linked to the health system. Taking into account all the actors that provide care and support to people with Parkinson' disease and family carers facilitates the creation of strategies that better respond to individual needs. Nurses and other health and social care professionals in the community and specialist levels of care should collaborate to develop multisectoral strategies that promote personalised and integrated care throughout the Parkinson's journey.

Recognition of Delirium Superimposed on Dementia: Is There an Ideal Tool?

Delirium in persons with dementia (DSD) is a common occurrence. Over the past three decades, several tools have been developed and validated to diagnose delirium, yet there is still a shortage of tools recommended in persons with dementia and there is a lack of sufficient research on the accuracy of performance of such tools in this growing population. The purpose of this article is to (1) conduct a clinical review of the detection of DSD across settings of care by formal health care professionals and informal family members and care partners; (2) identify barriers and facilitators to detection and highlight delirium tools that have been tested in person with dementia; and (3) make recommendations for future research, practice, and policy. Given this review, an "ideal" tool for DSD would point to tools being brief, easy to integrate into the EMR, and accurate with at least 90% accuracy given the poor outcomes associated with delirium and DSD. Knowing the baseline and communication between family members and healthcare professionals should be a top priority for education, research, and health systems policy. More work is needed in better understanding DSD and optimizing and standardizing feature assessment, especially the acute change feature at the bedside for DSD.

Program logic of a mental health outreach service for socially anxious youth

Youth mental health is a major concern both in Australia and internationally. Identifying at-risk young people is a core service priority. This report describes a “Youth Social Inclusion Program” developed in Australia to assist young people identified as having social difficulties that prevent them linking into formal mental health services. This report describes the Australian service context and uses the “program explication” methodology to document: the program activities, therapeutic processes, and underpinning evidence for the benefits of this service. Program explication is a consulting method designed to assist services to identify and review implicit program logic assumptions against evaluation literature. We demonstrate the application of this method in exploring the assumptions and evidence for the Youth Social Inclusion Program, targeting outreach to socially anxious young people in Australia. The Youth Social Inclusion Program involved seven logically consistent activities. Our literature search revealed moderate evidence for the expected benefits of the activities. This practice-based design drew on several theoretical perspectives. Given that the program logic has been established, we outline a proposal for further evaluation.

Aktivitas Antibakteri Ekstrak Metanol Daun Matenasi (Garcinia Sp.) Terhadap Staphylococcus Aureus dan Eschericia Coli

Medicinal plants are very popular among the people of Indonesia as traditional medicinal ingredients. Traditional medicine is a means of supporting public health for generations, long before formal health services and modern medicines touched the layers of society. One of the medicinal plants which is efficacious as a medicine for diarrhea is matenasi leaf (Garcinia sp). Diarrhea is an infectious disease that often occurs in Indonesia due to Escherichia coli bacteria. This study aims to determine the antibacterial activity of methanol extract using the paper disc diffusion method which is dripped with 10 µl of the test solution using a micro pipette. The concentrations of the methanol extract used were 50%, 75%, and 100% compared to the positive control, namely 30 µl chloramphenicol solution. Matenasi leaves using methanol extract have strong antibacterial activity at a concentration of 100%. For Staphylococcus aureus bacteria with a concentration of 100% with a diameter of 22.67 mm (very strong category), Escherichia coli bacteria with a concentration of 100% with a diameter of 18.25 mm (strong category). The methanol extract of matenasi leaves has the potential as an antibacterial against Stapylococcus aureus and Escherichia coli bacteria.

Task-shifting and family planning continuation: contraceptive trajectories of women who received their method at a community-based event in Kinshasa, DRC

While community-based interventions are a proven high-impact strategy to increase contraceptive uptake in low-income countries, their capacity to support women’s contraceptive choices (including continued use, switching and discontinuation) in the long run remains insufficiently discussed. This cohort study follows 883 women 3 and 6 months after they received a modern method during community campaigns organized in Kinshasa (D.R. Congo), to analyze their contraceptive trajectories and the factors associated with ever discontinuing contraceptive use in the first 6 months following a campaign. In the community-based distribution (CBD) model currently institutionalized in DRC, campaign clients are not provided with additional doses or support, besides baseline counseling, to (dis-)continue using the method they received, but must rely on Family Planning resources within the existing local health system. Almost a third (28.9%) of all women discontinued modern contraception during the study period, with much higher discontinuation rates for short-acting methods (38.7% for pills and up to 68.9% for DMPA-SC). Variables previously associated with high discontinuation (marital status, fertility intentions and side-effects) led to higher odds of “ever discontinuing”. However, these variables became non-significant when controlling for resupply issues. Women’s self-reported reasons for discontinuation confirmed the multivariate regression results. Detailed sub-analysis of resupply issues for pills, injectables and Cyclebeads pointed to the role of cost, unreliable campaign schedules and weak integration of community-based strategies into the formal health system. Extremely low rates of implants removal suggest similar access to FP services issues. The study highlights the need to identify CBD strategies best suited to support women’s choices and preferences towards successful contraceptive trajectories in fragile health systems.

Community and Informal Care Providers at the Heart of Universal Health Coverage in sub-Saharan Africa: A Position Paper

Globally, increased demand on often scarce healthcare resources and those challenges incumbent in responding to the coexistence of infectious and non-communicable diseases warrant the need to address persistent health inequities. Understanding the complex intersectionality of vulnerability and reaching those in most critical need of healthcare lies at the heart of fostering and sustaining resilient healthcare systems. Harnessing the long-recognised value of Community and Informal Care Providers (CICPs) is instrumental to Universal Health Coverage (UHC). The present COVID-19 context serves as a poignant example of where access to formal healthcare services by many has become increasingly difficult. Here, the value of informal or volunteer-led health services has been a lifeline for many. For several decades, formal reportage has evidenced the established role of CICPs, particularly across Sub-Saharan Africa with quantifiable efficacy across a number of domains, such as, maternal and child health, neglected tropical disease prevention, tuberculosis care and malaria control. CICPs have been sustainable and effective as a conduit between the formal and informal health sectors, and between health facilities and the remotest of communities. Maximising the function of CICPs relies on socio-culturally, geographically sensitive, and bespoke support; psychosocial, practical, and logistical capacitation coupled with situationally and culturally appropriate monitoring and evaluation. The Astana Declaration highlights the centrality of building on existing knowledge, insight and resource. We therefore argue that CICPs are indispensable in Africa’s move towards UHC, and hold promise for acceptable, accessible, affordable, and quality healthcare to everyone who needs to get, be and stay healthy.

Approaching the dermatologic care of people experiencing unsheltered homelessness through a volunteer street dermatology model

To the Editor: Although contemporary health care delivery models aim to tackle health care disparities, the most vulnerable patient populations continue to suffer from reduced access to care. A street-based approach presents a framework for clinical outreach to this truly underserved population that bears a disproportionate burden of disease.1Petrovich J.C. Hunt J.J. North C.S. Pollio D.E. Roark Murphy E. Comparing unsheltered and sheltered homeless: demographics, health services use and predictors of health services use.Community Ment Health J. 2020; 56: 271-279https://doi.org/10.1007/s10597-019-00470-0Crossref PubMed Scopus (9) Google Scholar Patients who would otherwise be unable to attend structured, charitable clinics can instead be evaluated in their own setting and on their own terms. Such “house-calls for the homeless” can bridge notable gaps in care, especially for essential yet difficult to access services like dermatology.2Stefanowicz M. Feldman B. Robinson J. House calls without walls: street medicine delivers primary care to unsheltered persons experiencing homelessness.Ann Fam Med. 2021; 19: 84https://doi.org/10.1370/afm.2639Crossref PubMed Scopus (3) Google Scholar The distinction between sheltered and unsheltered populations is not often made in medical literature, as previous studies involving people experiencing homelessness utilize shelter-based cohorts.3Koh K.A. Roncarati J.S. Racine M.W. O'Connell J.J. Gaeta J.M. Unsheltered vs. Sheltered adults experiencing homelessness: health care spending and utilization.J Gen Intern Med. 2022; 37: 2100-2102https://doi.org/10.1007/s11606-021-07153-1Crossref PubMed Scopus (1) Google Scholar In the absence of reliable shelter, people experiencing unsheltered homelessness (PEUH) are exposed to conditions that increase their risk of suboptimal dermatologic health leading to cellulitis and osteomyelitis.4Raoult D. Foucault C. Brouqui P. Infections in the homeless.Lancet Infect Dis. 2001; 1: 77-84https://doi.org/10.1016/S1473-3099(01)00062-7Abstract Full Text Full Text PDF PubMed Scopus (167) Google Scholar Street Dermatology is a model to provide direct dermatologic care for PEUH living near sidewalks, encampments, and overpasses. Many of these patients live in squalid conditions with both food and medical insecurity, and lack the means to coordinate formal health care visits. After registering with the state health department, ethical approval was obtained by the University of Miami Institutional Review Board (IRB) in conjunction with established volunteer street medicine providers. PEUH encountered face-to-face were offered basic medical care by a team of providers supervised by a physician. Although board-certified dermatologists were invited to participate in the outreach, most initial dermatologic input was provided via store-and-forward telemedicine (Fig 1). Skin conditions were documented among 160 PEUH encountered in Miami-Dade County from January to June 2022. A total of 125 dermatologic diagnoses (Table I) were made. We reviewed patient history, clinical presentation, and recommended treatment weekly. There was a wide distribution of dermatologic disease noted, with infectious (28.0%, n = 35), inflammatory (24.0%, n = 30), ulcers/erosion/wounds (12.8%, n = 16), UV-induced/neoplastic disorders (10.4%, n = 13), and pruritus (7.2%, n = 9) being prevalent. Patients received treatment and education about their condition including preventative measures. Patient information was stored on a secure, custom REDCap medical record.Table IDermatologic conditions encountered over a 6-month periodType of conditionNumber of diagnoses (% of total)Inflammatory30 (24.0) Acne4 (3.2) Pseudofolliculitis barbae1 (0.8) Dermatitis20 (16.0)Contact5 (4.0)Chronic dermatitis/Lichen simplex chronicus8 (6.4)Photodermatitis2 (1.6)Venous3 (2.4)Unspecified2 (1.6) Psoriasis2 (1.6) Seborrheic dermatitis2 (1.6) Lichen planus1 (0.8)Infectious35 (28.0) Tinea cruris1 (0.8) Tinea pedis10 (8.0) Tinea manuum1 (0.8) Onychomycosis10 (8.0) Verruca vulgaris4 (3.2) Erosio interdigitalis blastomycetica5 (4.0) Pityriasis versicolor1 (0.8) Scabies3 (2.4)Ulcerations/erosions/wounds16 (12.8) Erosions and wounds11 (8.8) Burn2 (1.6) Post-trauma scars3 (2.4)Nail disorders6 (4.8) Paronychia2 (1.6) Micronychia1 (0.8) Leukonychia1 (0.8) Beau’s lines1 (0.8) Clubbing1 (0.8)Pruritus10 (8.0) Prurigo nodularis1 (0.8)Cutaneous neoplasm or UV damage13 (10.4) Seborrheic keratosis6 (4.8) Actinic keratosis3 (2.4) Solar lentigo2 (1.6) Idiopathic guttate hypomelanosis1 (0.8) Melanoma1 (0.8)Miscellaneous10 (8.0) Arthropod assault4 (3.2) Acrochordon1 (0.8) Corns1 (0.8) Ichthyosis vulgaris1 (0.8) Xerosis2 (1.6) Terra firma-forme dermatosis1 (0.8)Unspecified, requiring dermatology evaluation5 (4.0)Total125 (100) Open table in a new tab Life-changing diagnoses were also made. For roughly 15 years, one patient had a slow growing, quarter-sized hyperpigmented lesion on his cheek. During street evaluation, the characteristics of his lesion raised concern for melanoma. He was immediately connected to our dermatology service where he received biopsies which confirmed the diagnosis of melanoma at a depth of 1 mm. Subsequently, surgery was coordinated. In this way, PEUH could now be connected to reliable, specialized care. This model’s reproducibility varies on a regional basis but can be adopted by a multidisciplinary team of medical providers, educators, and social workers.5Doohan N.C. Mishori R. Street medicine: creating a “classroom without walls” for teaching population health.Med Sci Educ. 2019; 30: 513-521https://doi.org/10.1007/s40670-019-00849-4Crossref PubMed Scopus (6) Google Scholar Notable drawbacks include unpredictability of follow-up care due to the inherently informal structure of our evaluations. Funding is dependent on charitable contributions and first-line treatments may be unavailable. Such outreach works for patients whose condition does not warrant urgent medical care but still requires timely management. Street Dermatology demonstrates the vital role our specialty can play in the care in one of the most underserved populations. None disclosed.

History and Politics of Medication Abortion in the United States and the Rise of Telemedicine and Self-Managed Abortion.

This article examines the decades-long campaign to increase access to abortion pills in the United States, including advocates' work to win US Food and Drug Administration approval of mifepristone and misoprostol for abortion, the continuing restrictions on mifepristone, and the multiple strategies advocates have pursued to challenge these restrictions, including lobbying the FDA to remove the restrictions, obtaining a limited research exemption from FDA restrictions, and suing the FDA during the COVID-19 pandemic. The article pays particular attention to the influence of research conducted on the safety and efficacy of medication abortion as well as research on the impact of increased availability of abortion pills through telemedicine during the pandemic. The article also addresses self-managed abortion, wherein people obtain and use mifepristone and/or misoprostol outside the formal health care system, and it documents the growing network of organizations providing logistical, medical, and legal support to people self-managing abortion. The article concludes with reflections on the role abortion pills might play in the post-Roe era amid increasingly divergent abortion access trends across different regions of the United States.

Religious Moderation among The Nahdlatul Ulama and Muhammadiyah

In recent times in Indonesia, the outlook and attitudes of a person or group of people with religious devotion are likely to be severe, extreme, and intolerant. Furthermore, some are too liberal. Based on the phenomenon, the authors were moved to seek a solution of a sensible way of view and religious attitude (taking a middle and peaceful path) through religious moderation performed by the Nahdlatul Ulama and the Muhammadiyah. This type of research is field research with a qualitative approach, and the method used is a comparative description. A combination of interviews, observation, and documentary studies do the writer’s data collection. As for the analysis, the authors used descriptive analytic data analysis techniques. According to research, Nahdlatul Ulama is an Islamic organization practicing modernity and religion, accommodating tradition and culture, culinary activity, and its deep-rooted message base. In comparison, Muhammadiyah’s religious moderation was performed through Muhammadiyah charity enterprises in formal education, health, and religious dialogue. Nahdlatul Ulama and Muhammadiyah, in certain aspects, are different, though not principles, only branches in the doctrine of Islam. When it comes to religious moderation, both are moderate, having a tolerant attitude with members of other faiths and those of differing religious people, being impartial and neither extreme.

Factors associated with health care seeking behaviour: A cross-sectional study at an emergency department in a teaching hospital

BACKGROUNDEmergent conditions are time-sensitive and delays in receiving emergency care can cause mortality and morbidity. Different healthcare-seeking behaviours (HSB) are influenced by several factors which impact choices in seeking healthcare. This study aimed to determine the factors associated with HSB among patients admitted to the Emergency Department of Korle Bu Teaching Hospital (KBTH).METHODOLOGYThis was a cross-sectional study among patients admitted at the Accident and Emergency Centre of KBTH from May to June 2020 using the quantitative approach in data collection. Simple random sampling was used to select 400 participants who met the inclusion criteria after which the questionnaires were administered. Participants were assessed on their HSB based on Andersen's Behavioural Model of Health. Pearson's chi-square test was used to assess the association between categorical independent variables and the HSB of patients while Welch’s t-test was used to compare means of triage vital signs at admission between patients who sought formal and informal care. All factors significant from Pearson's chi-square test were introduced into the binary logistic regression model. P-values less than 0.05 were considered statistically significant in this study.RESULTSOf the 400 respondents interviewed, the mean age was 51 years with 56.5% being women. The majority of respondents (61.50%) sought formal health care as their initial action when sick whiles the remaining sought informal care. The adjusted odds for seeking formal health care were higher among patients who self-rated their illness as severe, those who travelled more than 30 minutes to the nearest health facility and those who were classified as red according to South African Triage Scale (SATS).CONCLUSIONSelf-rating of the severity of illness, distance to health facility and patient classification as red by SATS were significant factors associated with healthcare-seeking behaviour. Knowledge about the factors associated with healthcare-seeking behaviour is vital for health education and health promotion campaigns towards appropriate health care seeking behaviour.