Formal Health Research Articles

Enhancement of Preoperative Mental Health Assessment Through Clinical Nurse Specialist Project Leadership.

The aim of the project was to discern whether a collaborative, consultative-rich, clinical nurse specialist-led project could increase completion rates of a patient health questionnaire for depression and a generalized anxiety disorder questionnaire with appropriate referrals in adult patients in the ambulatory and hospital settings of a robust cardiovascular surgery practice before cardiovascular surgery. The Define, Measure, Analyze, Improve, Control implementation methodology guided this quality improvement project. The workflow was analyzed in collaboration with stakeholders, and barriers to and facilitators of questionnaire completion were identified. Interpreter services partnerships were enhanced and used for patients with a preferred language other than English. Weekly data analysis assessed ongoing questionnaire completion rates. Documented completion rates of questionnaires improved across ambulatory and hospital settings by 15%. Patients with a preferred language other than English had an 80-percentage-point increase in documented questionnaire completion. Clinical nurse specialists are poised to lead projects because of their use of the collaborative and consultative core competencies. A formal electronic health record report was established for monitoring outcomes. Embedding questionnaire administration within the standard workflow of ambulatory and hospital staff makes administering questionnaires preoperatively a sustainable practice in both settings.

A history of arts and health in South Australia: Policy and practice

This article traces the history of arts and health in South Australia, using an interview-based methodology to detail how grassroots practice developed into formal arts and health policy. The project interviewed 47 arts and health stakeholders, including former state government ministers, artists and health professionals. South Australia has a long history of arts and health work. However, interviewees describe a lack of momentum for the field since the endorsement of the 2013 National Arts and Health Framework, largely because it did not contain binding commitments which left the field vulnerable to changes associated with political leadership. South Australia thus represents both a case study of how grassroots support can maximize political interest in arts and health to create formal policy as well as a warning on the challenges that occur when this interest wanes.

Tailoring HIV Care for Black Populations: A Pilot Feasibility Prospective Cohort Study.

Research has shown that integrating community health workers (CHWs) into the formal health care system can improve outcomes for people living with HIV, yet there is limited literature exploring this framework among marginalized minority populations. Herein, we discuss the feasibility of a clinic-embedded CHW strategy to improve antiretroviral therapy adherence among Black people living with HIV in Miami-Dade County, Florida, a designated priority region for the US Department of Health and Human Services' Ending the HIV Epidemic Initiative. From December 2022 to September 2023, three CHWs were trained and integrated into the hospital workflow to provide support as members of the clinical team. Ten Black adults with an HIV viral load over 200 copies/mL were enrolled to received 3 months of CHW support focused on navigating the health system and addressing poor social determinants of health. Intervention feasibility was based on 4 criteria: recruitment rate, demographic composition, study fidelity, and qualitative feedback on CHW perceptions. Participants were recruited at a rate of 5.7 participants per month, with the sample evenly distributed between men and women. Retention was moderately strong, with 7 (70%) of the 10 participants attending more than 75% of CHW sessions. Qualitative feedback reflected CHW perceptions on clinical interactions and intervention length. Outcomes indicate that a clinic-integrated CHW approach is a feasible and acceptable methodology to address adverse social determinants and improve HIV treatment adherence. By offering targeted social and clinical support, CHWs may be a promising solution to achieve sustained viral suppression and care engagement for Black people living with HIV.

Older Adults Affected by Abuse-What about Their Mental Health and Social Participation? A Mixed Methods Study.

The purpose of the study was to describe what types of abuse of older adults the healthcare providers in hospital emergency departments are currently able to identify. The study aimed at producing new information about the identification of abuse to enable the development of staff skills in the identification of abuse and in optimal interventions. The study is the first on the topic from the perspective of hospital emergency staff in Finland. The 76 participants represent 5 hospitals. The results are based on a statistical analysis of quantitative questions and on an inductive content analysis of participant experiences of suspected abuse. The inductive content analysis revealed that older adults subjected to abuse have narrowed social networks and many of them surrender to loneliness. Based on the relevant literature, the study discusses how the formal and informal social participation and mental health of this group of people could be promoted. Given the current limited resources, it is proposed that the idea of social prescribing might be applied informally, with help of a volunteer link person. Any interventions should be based on the older adults' conceptions of what is meaningful to them.

Help-Seeking, Support, and Engagement in Gestational Diabetes Mellitus Online Communities on Facebook: Content Analysis.

The prevalence of gestational diabetes mellitus (GDM) has drastically risen in recent years. For some, self-management includes the use of GDM online communities on Facebook. Such communities can fill gaps in information and support that participants are not able to access elsewhere to address unmet needs. Given the popularity of sharing information about pregnancy on Facebook and the documented benefits of diabetes online communities, the same may be true of GDM online communities. This study aimed to categorize and quantify what is being discussed in GDM Facebook groups, including informational and emotional help-seeking behavior, and how this support and engagement may be demonstrated by peers through comments and reactions. We sourced the data from the 2 largest Facebook groups focused on GDM in Australia. A summative content analysis was conducted on original posts across the 2 groups and coded for topics as well as help-seeking types. The coding scheme was based on the previous work of Liang and Scammon. Visible indicators of engagement, including the number of comments and "reactions," were tabled and manually evaluated. There were 388 original posts, and the analysis produced 6 topics: GDM self-management (199/388, 51.3%), GDM clinical management (120/388, 30.9%), preparing for birth (40/388, 10.3%), mental distress (35/388, 9%), birth announcement (29/388, 7.5%), and GDM journey reflections (21/388, 5.4%). Secondary coding of help-seeking type revealed more than half of the posts were informational help-seeking (224/388, 57.7%), while a small proportion were both informational and emotional help-seeking (44/388, 11.3%), and some (12/388, 3.1%) were emotional help-seeking only. Self-disclosure was identified as a fourth category, comprising almost a quarter of all posts (90/388, 23.2%). A total of 6022 comments were posted in response to the original posts, and there were 4452 reactions across all posts. Emotional help-seeking attracted the most comments per thread (mean 21.5, SD 19.8), followed by informational and emotional help-seeking (mean 20.2, SD 14.7), informational help-seeking (mean 15.6, SD 14.6), and self-disclosure (mean 14.3, SD 21.8). Across all help-seeking categories, few reactions occurred compared to comments; in contrast, self-disclosure attracted a large number of reactions (mean 9.4, SD 45.3). This is one of the first studies to examine peer support in a GDM online community on Facebook. Our findings suggest that active participants' needs around information and support in relation to GDM are being somewhat met by peer-led online communities. Given the practical limitations of formal health care, including the provision of ongoing social support, it is important to recognize how GDM online communities can complement formal health care and help address unmet needs.

Cluster of Nontoxigenic Corynebacterium diphtheriae Infective Endocarditis and Rising Background C. diphtheriae Cases-Seattle, Washington, 2020-2023.

Nontoxigenic Corynebacterium diphtheriae, often associated with wounds, can rarely cause infective endocarditis (IE). Five patients with C. diphtheriae IE were identified within 12 months at a Seattle-based hospital system. We reviewed prior C. diphtheriae-positive cultures to determine if detections had increased over time and evaluated epidemiologic trends. We conducted a formal electronic health record search to identify all patients aged ≥18 years with C. diphtheriae detected in a clinical specimen (ie, wound, blood, sputum) between 1 September 2020 and 1 April 2023. We collected patient demographics, housing status, comorbidities, substance-use history, and level of medical care required at detection. We extracted laboratory data on susceptibilities of C. diphtheriae isolates and on other pathogens detected at the time of C. diphtheriae identification. Between 1 September 2020 and 1 April 2023, 44 patients (median age, 44 years) had a C. diphtheriae-positive clinical culture, with most detections occurring after March 2022. Patients were predominantly male (75%), White (66%), unstably housed (77%), and had a lifetime history of injecting drugs (75%). Most C. diphtheriae-positive cultures were polymicrobial, including wound cultures from 36 (82%) patients and blood cultures from 6 (14%) patients, not mutually exclusive. Thirty-four patients (77%), including all 5 patients with C. diphtheriae IE, required hospital admission for C. diphtheriae or a related condition. Of the 5 patients with IE, 3 died of IE and 1 from COVID-19. Findings suggest a high-morbidity outbreak disproportionately affecting patients who use substances and are unstably housed.

Factors Influencing Health Service Utilization in Ishaka Division, Bushenyi-Ishaka Municipality: Insights and Implications

Factors influencing the utilization of health services at the community level are crucial for reducing morbidity and mortality rates. This study aimed to investigate these factors within the Ishaka division of Bushenyi-Ishaka municipality. Utilizing a descriptive cross-sectional study design, data was gathered from 200 adult residents and caregivers using a structured questionnaire administered through cluster and systemic random sampling. Descriptive statistics were employed to analyze quantitative data, revealing socio-demographic characteristics, reported health service utilization, and factors influencing it. Results indicated that health service utilization among participants was lower than the national average. Identified factors affecting utilization included poverty, limited accessibility to formal health services, negative attitudes of health personnel, and insufficient supply of essential medicines and materials at health facilities. Overall, health service uptake was moderate but slightly below national targets. This study provides valuable insights into health service utilization and the barriers hindering further uptake at the community level in Bushenyi-Ishaka Municipality, with significant implications for local and national health policy. Keywords: Health service, Caregivers, Health personnel, Health facility, Medicines

Hepatitis E outbreak in the health district of Bocaranga-Koui, Central African Republic, 2018–2019

BackgroundHepatitis E virus (HEV) is a major public health disease causing large outbreaks and sporadic cases of acute hepatitis. We investigated an outbreak of HEV infection that occurred in September 2018 in the health district (HD) of Bocaranga-Koui, located in the northwestern part of Central African Republic (CAR).MethodsBlood samples were collected from 352 patients aged 0–85 years suspected to be infected with yellow fever (YF), according to the World Health Organization YF case definition. The notification forms from recorded cases were used. Water consumed in the HD were also collected. Human samples found negative for anti-YF IgM were then tested by ELISA for anti-HEV IgM and IgG antibodies. Positive anti-HEV (IgM and/or IgG) samples and collected water were then subjected to molecular biology tests using a real time RT-PCR assay, followed by a nested RT-PCR assay for sequencing and phylogenetic analysis.ResultsOf the 352 icterus patients included, anti-HEV IgM was found in 142 people (40.3%) and anti-HEV IgG in 175 (49.7%). Although HEV infection was detected in all age groups, there was a significant difference between the 0–10 age groups and others age groups (P = 0.001). Elevated levels of serum aminotransferase were observed in anti-HEV IgM-positive subjects. Phylogenetic analysis showed HEV genotype 1e in infected patients as well as in the contaminated water.ConclusionThis epidemic showed that CAR remains an HEV-endemic area. The genotype 1e strain was responsible for the HEV outbreak in Bocaranga-Koui HD. It is necessary to implement basic conditions of hygiene and sanitation to prevent further outbreaks of a HEV epidemics, to facilitate access to clean drinking water for the population, to launch intensive health education for basic hygiene measures, to sett up targeted hygiene promotion activities and, finally, to ensure that formal health care is available.

Mapping mental health care services for children and youth population in Colombia’s Pacific: potential for boundary spanning between community and formal services

BackgroundConflict and violence can impact on the mental health of children and young people, who are in a crucial stage of their personal growth. Not much is known about the provision of mental health care to young people in conflict-affected areas. Community-based care can be essential, as state-led services are often scarce in conflict contexts, like Colombia’s Pacific region where this research was conducted. According to the WHO, such care is ideally provided in the form of a network of interconnected services, offered by different actors beyond the formal health sector. This article describes the relationship between the formal and community mental health systems in Colombia’s Pacific region, and identifies ways of improving their interaction.MethodsQualitative data were collected through 98 semi-structured interviews with community organisations, schools, international organisations and state institutions. These interviews aimed to identify the strategies used to promote young people’s mental health and the interactions between the different providers. Boundary spanning theory was used to analyse how different actors and forms of mental health care provision could coordinate better.ResultsCommunity organisations and schools use a wide array of strategies to attend to the mental health of children and young people, often of a collective and psychosocial nature. State institutions offer more clinically focused strategies, which are however limited in terms of accessibility and continuity. International organisations aim to strengthen state capacity, but often struggle due to high staff turnover. Although mental health care pathways exist, their effectiveness is limited due to ineffective coordination between actors.ConclusionsTo make sure that the variety of strategies to improve young people’s mental health effectively reach their beneficiaries, better coordination is needed between the different actors. Mental health care pathways should therefore integrate community organisations, while community connectors can help to manage the coordination between different actors and forms of clinical and psychosocial support.

Perspectives of community and facility stakeholders on community health workers in rural Malawi.

Community health workers (CHWs) bridge the primary health care (PHC) system and communities by providing care in the household. In Malawi, few studies have examined the perspective of users of household-level CHW services, in remote areas, to understand CHW's role in community-based PHC. To explore perspectives of community and facility stakeholders on the enablers and challenges of the CHW role in community-based PHC in Neno District. The study was conducted in the Neno District health facilities, namely, Ligowe, Dambe, Chifunga, and Zalewa. We conducted eight focus group discussions (FGDs) with purposively sampled community members and conveniently sampled facility stakeholders. Data were transcribed and analysed thematically through an adapted COM-B model of behaviour change. Three main themes of perceived behaviour change within the CHW role were identified: (1) capacity - the CHW programme aids health education and promotion within the community; (2) opportunity - the CHW programme facilitates community-based PHC and linkage to the facility; and (3) motivation - the CHW programme enablers and challenges in providing community-based PHC. Community health workers enrich community-based PHC delivery through health education, timely access to care, and linking communities to the facility. Optimising workload and programme support is critical for the help of CHWs. Further studies are required to address programme and cultural challenges to enhance positive health-seeking behaviours.Contribution: This study provides contextual knowledge for further research on bringing together spiritual and formal health practices and considering the cultural background when planning for health interventions in remote areas.

Strategies to Improve Access to Mental Health and Psychosocial Support Among Displaced Populations in Ethiopia

Background: In 2021, more than 23 million people were in need of humanitarian assistance in Ethiopia, including four million internally displaced persons and returnees. Displaced populations face an elevated risk of mental health and psychosocial problems, yet they often have limited access to mental health and psychosocial support. Objective: This study aimed to assess: 1) the mental health and psychosocial needs and resources among displaced persons in Ethiopia; and 2) examine barriers, and facilitators, and identify strategies to improve access to culturally appropriate mental health and psychosocial support in this population and context. Methods: We conducted a sequential mixed-methods assessment of mental health and psychosocial needs and resources. First, we conducted 16 key informant interviews with those who had experience and knowledge regarding the mental health situation of displaced persons in Ethiopia, including mental health providers and humanitarian practitioners. Second, we conducted an assessment of available mental health services in 15 internally displaced persons (IDP) sites in Ethiopia along with 28 key informant interviews in this context to explore some of the challenges and strategies to improving access to mental health and psychosocial support. Results: Access to mental health services was limited in IDP sites. Participants identified numerous barriers to accessing services that ranged from limited supply and fragmentation of existing mental health services to an incongruence between formal mental health services and explanatory models of mental illness. Strategies to address these barriers included engagement of community members and key stakeholders (e.g., traditional and religious healers), improving mental health literacy, strengthening referral systems and mental health capacity, and improving coordination and integration of mental health within the national health system. Conclusion: This study highlights several challenges and opportunities for improving access to mental health and psychosocial support among displaced persons in Ethiopia. Efforts to bridge gaps in access to mental health and psychosocial support must consider both systems-level factors that influence availability as well as community factors influencing perceptions and acceptability of services within this context.

Viable justice: survivors of sexual and gender-based violence and/or torture amongst South Sudanese refugees living in settlements in Northern Uganda

PurposeThe study aimed to listen to refugee survivors of sexual and gender-based violence (SGBV) and/or torture and explore what justice meant to them in exile. This study argues that what the survivors who participated in this research wanted was “viable justice”. The research was funded by the British Academy and Leverhulme Trust.Design/methodology/approachUsing a survivor-focussed justice lens combined with a trauma-informed approach, narrative interviews were held with 41 women and 20 men refugee survivors living in refugee settlements in Northern Uganda. The researchers also conducted semi-structured interviews with 37 key informants including refugee welfare councils, the UN, civil society, non-government and government organisations. Thematic analysis of the data resulted in the following themes being identified: no hope of formal justice for atrocities that occurred in South Sudan; insecurity; lack of confidence in transitional justice processes in Ugandan refugee settlements; abuse and loss of freedom in refugee settlements; and lack of access to health and justice services in refugee settlements.FindingsThis study argues that what the survivors who participated in this research wanted was “viable justice”. That is justice that is survivor-centred and includes elements of traditional and transitional justice, underpinned by social justice. By including the voices of both men and women survivors of SGBV and/or torture and getting the views of service providers and other stakeholders, this paper offers an alternative form of justice to the internationally accepted types of justice, which offer little relevance or restitution to refugees, particularly where the crime has been committed in a different country and where there is little chance that perpetrators will be prosecuted in a formal court of law.Research limitations/implicationsThe research findings are based on a small sample of South Sudanese refugees living in three refugee settlements in Northern Uganda. Thus, wider conclusions should not be drawn. However, the research does suggest that a “viable justice” approach should be implemented that is gender and culturally sensitive and which could also be trialled in different refugee contexts.Practical implicationsImprovements in refugee survivors’ dignity, resilience and recovery are dependent upon the active engagement of refugees themselves using a “survivor-focussed approach” which combines formal and community-based health services with traditional and transitional justice responses.Social implicationsThe provision of a “viable justice approach” ensures those who have experienced SGBV and/or torture, and their families, feel validated. It will assist them to use their internal, cultural and traditional resilience and agency in the process of recovery.Originality/valueThe research findings are original in that data was collected from men and women survivors of SGBV and/or torture and service providers. The empirical evidence supports this study’s recommendation for an approach that combines both formal and survivor-focussed approaches towards health and viable justice services to meet the needs of refugees living in refugee settlements. This is a response that listens to and responds to the needs of refugee survivors in a way that continues to build their resilience and agency and restores their dignity.

Determinants of intentions to seek formal mental health help among Palestinian adolescents in Israel.

Mental health challenges are widespread among adolescents undergoing significant physical, emotional, social, and academic changes. However, rates of formal help-seeking remain low, particularly among those from ethnic minorities. This study investigated the determinants of intentions to seek formal mental health help among Palestinian adolescents in Israel, focusing on mental health literacy (MHL) and trust in formal sources of information. A total of 178 adolescents (Mage = 16.24 ± 1.24 years, 61.8% female) completed measures assessing intention for formal help-seeking, psychological distress, MHL, trust in formal sources of information, sociodemographic, and clinical characteristics. Findings revealed low levels of intention to seek formal help and psychological distress, alongside average or above-average levels on all MHL dimensions and trust in formal sources for information. Our analysis identified socioeconomic status (β = .17, p < .05), psychological distress (β = .18, p < .05), trust in formal sources of information (β = .28, p < .001), and two MHL dimensions: knowledge of where to seek information (β = .25, p < .01) and attitudes that promote recognition or appropriate help-seeking behavior (β = .16, p < .05) - as the main determinants of intention for formal help-seeking. This study underscores the critical role of trust in formal sources of information and MHL in seeking formal help among adolescents from ethnic minorities. Interventions aiming to improve access to mental health-related information, address and enhance attitudes, and foster trust in formal professionals and institutions may contribute to an increased tendency for formal mental health help-seeking among this population and others.

Child and adolescent mental health services in Khartoum State, Sudan: a desktop situational analysis.

Sudan is a Northeast African country, with 61.7% of its population under 24 years. With a large youth population and significant cultural and linguistic diversity, Sudan, like most low-income countries, has contributed minimal data to global child and adolescent mental health (CAMH) research. This study aimed to perform the first ever situational analysis of CAMH services and systems in Khartoum State, Sudan. The study focused on Khartoum state and covered the calendar years 2019 and 2020. Using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) version 2.2 adapted for CAMH, the study focused on the publically available data sources. Findings were described and presented in tables and figures using the WHO-AIMS template. The situational analysis found no CAMH-specific policies, no separate budget for CAMH, and no supervising body for CAMH services in Khartoum. Three tertiary mental health hospitals provided CAMH services, all combined with adult mental health services. Essential medicines were available in all facilities, except methylphenidate available only in 3 central pharmacies. There was no free access to essential psychotropic drugs for children and adolescents except in emergency settings. Data about training to primary healthcare providers and the process of referral to specialized services were limited. A school mental health programme existed which provided early identification and management of CAMH problems in schools. The workforce was small and variable across all levels of care. No formal public health awareness campaigns and little evidence of formal intersectoral collaboration on CAMH were identified. A health information system existed, but no CAMH-specific items were reported. Among a handful of publications on CAMH, no national studies on CAMH were identified. This situational analysis represented the first systematic collation of data and information about CAMH in Sudan. Findings highlighted some areas of strength, but also many gaps in CAMH services and systems. We acknowledge the need to complement the desktop analysis with in-depth data collection with stakeholders across multiple levels, but hope that this will serve as a first step towards strengthening CAMH services in Sudan and other low-income countries.

Ocular morbidity patterns among metal workers from an unorganized sector: A cross-sectional study

Introduction and Aim: The metal working process has many hazards that the metal workers are exposed to resulting in several health disorders and diseases. However, there is a lack of documented information regarding the prevalence of ophthalmic safety practices and the factors influencing them among metal workers in the Moradabad region or the study area. The aim of the present study is to assess ocular morbidity patterns among the metal workers from an unorganized sector. Methods: We conducted this study to find out the morbidity patterns among the metal workers working in Northwestern Uttar Pradesh, district Moradabad. A cross-sectional study was conducted among 100 metal workers using a pre-validated structured questionnaire. Results: All the metal workers working, without any formal eye health and safety training. Eye Injury was the most common problem at work. The age of the metal workers, duration of employment &amp; welding hours per day were associated with ocular morbidities among the metal workers. In this study, among 100 metal workers, 18% of workers were suffering from an occupational eye injury. 98% metal workers population don’t have any personal protective eye device.86% of them feel this protective eye device is not so necessary. Conclusion: There is a need for occupational health safety awareness services for metal workers in Moradabad as well as in Uttar Pradesh. While further research may be required to make policy recommendations, the current study provides a baseline morbidity burden among these mental workers to look for interventions to promote health and safety at work for this neglected unorganized group.

P1005 Dose escalated Infliximab in Inflammatory Bowel Disease - Crohn's Colitis Cure (CCC) Data Insights Program

Abstract Background Infliximab (IFX) is a monoclonal antibody targeting TNF-α and remains a cornerstone of management of Inflammatory Bowel Disease (IBD). A significant number of people with IBD on standard IFX therapy have persistent disease activity and require dose escalation (DE). In Australia and many other healthcare systems, funding through pharmaceutical benefits schemes is only available for standard dosing. We aim to evaluate the role of DE IFX and patient outcomes in a real-world cohort. Methods We performed a cross-sectional observational study using data from Crohn’s Colitis Care, a cloud-based IBD specific electronic medical record used in routine care in Australasia. Data were extracted in November 2023 from 14 private and public care centres. DE was defined as dosing interval &amp;lt;8 weeks and/or dosing &amp;gt;5mg/kg. We examined IBD outcomes prior to and 12 months post DE. Results A total of 1725 people received IFX, with DE in 762 (44.2%); 65% had Crohn’s Disease (CD), 33% had ulcerative colitis (UC) and 2% IBD-Unclassified (IBD-U), with a relatively even gender distribution (52.5% male). In the DE cohort, median age was 37 years (IQR 27-49); median age at diagnosis was 23 years (IQR 16-32) and median disease duration 11.6 years (IQR 5.8-17.3). DE and standard dose cohorts did not differ by IBD classification, gender, disease duration, age or age at diagnosis. Median drug level was higher 12-months post DE (8.16μg/ml vs 3.65 μg/ml). Faecal calprotectin (FCP) remission rate (FCP &amp;lt;250μg/g) was higher 12 months post DE, as was endoscopic remission rate and patient reported outcome remission (Table 1). The rate of systemic corticosteroids was lower 12 months post-DE than pre-DE. In the DE-IFX cohort, measures of healthcare utilisation were lower 12-months post-DE; hospitalisation (56 vs 146; p&amp;lt;0.001), surgical interventions (41 vs 61; p=0.040), endoscopic procedures (210 vs 397, p&amp;lt;0.001) and radiological investigations (243 vs 343; p&amp;lt;0.001). Conclusion Within a large Australasian IBD cohort, many individuals on IFX required DE. DE IFX was associated with improved measures of remission as well as a reduction in several measures of healthcare utilisation. These data will be used to undertake formal health economic analysis to determine the price points at which DE is cost-effective; additional data on quality of life and indirect healthcare costs will be important to include for a robust holistic assessment of value in care.

Strategic (Non)Disclosure: Activation and Avoidance of Social Ties among Women Seeking Abortion.

The increased politicization of sexual and reproductive health has created barriers to medically necessary care. In absence of formal health care, social ties become critical sources of information and resources, yet the disclosure of stigmatized health needs carries significant risk. How do people navigate the risks and benefits of disclosure when seeking care for stigmatized needs? Drawing on original survey data (N = 153) and in-depth interviews (N = 55) with women who attempted a self-managed abortion, I first describe the distinct roles of weak and strong ties in women's health-seeking experiences. I then demonstrate how both partial disclosure and nondisclosure are critical tools for obtaining information, resources, and emotional support during periods of health-seeking. Findings advance understanding of disclosure as a continuum that can be strategically wielded by people with stigmatized needs to confront and evade stigma and surveillance from their networks, the state, and the formal health care system.

Prospects for the development of community-based care in remote rural areas: a stakeholder analysis in Laos

BackgroundCommunity-based health programmes have been a cornerstone of primary care in Laos for decades. The study presented here aimed to document prospects for the development of current programmes, considering perceptions about health and health care priorities in the communities, implementation challenges, the policy landscape and opportunities associated with the availability of new technologies.MethodsThe research design primarily involved qualitative in-depth interviews with stakeholders (n = 35) responsible for the planning, management, or implementation of community-based care in Laos at different levels of the health system. These included health managers at central departments or institutes of the Ministry of Health, provincial health departments, district health offices, heads of health centres, village health volunteers, community representatives, and international stakeholders.ResultsThere was consensus that service delivery is still a challenge in many areas, due to geographic inaccessibility of health facilities, communication barriers, health-seeking behaviour, trust, and gender discrimination, particularly among ethnic minorities. In these settings, community health workers have the potential to extend the reach of the formal health system, acting as cultural brokers across sectors of society, ethnicities, and worldviews. To maximise impact, planners need to carefully consider the implementation model, financing arrangements, health system integration, and changing health priorities in the communities.ConclusionsThis study examined challenges to, and opportunities for, the expansion and health system integration of community-based care in Laos. Further development and horizontal integration of community-based care remains a complex financing and governance challenge, although the renewed emphasis on primary care and the ongoing process of decentralisation provide a favourable policy environment in the country to sustain and potentially expand existing programmes.

The paradoxical surplus of health workers in Africa: The need for research and policy engagement.

In many countries in Africa, there is a 'paradoxical surplus' of under and unemployed nurses, midwives, doctors and pharmacists which exists amidst a shortage of staff within the formal health system. By 2030, the World Health Organisation Africa Region may find itself with a shortage of 6.1 million health workers alongside 700,000 un- or underemployed health staff. The emphasis in policy debates about human resources for health at most national and global levels is on staff shortage and the need to train more health workers. In contrast, these 'surplus' health workers are both understudied and underacknowledged. Little time is given over to understand the economic, political and social factors that have driven their emergence; the ways in which they seek to make a living; the governance challenges that they raise; nor potential interventions that could be implemented to improve employment rates and leverage their expertise. This short communication reflects on current research findings and calls for improved quantitative and qualitative research to support policy engagement at national, regional and global levels.

Health Seeking Behavior and Self-Medication Practice among Undergraduate Medical Students in a Selected Private Medical College in Bangladesh

There is a need to have a formal health program for the medical students, set guidelines for students to follow if they fall ill and provision of rational medication. Students need to be made aware of the dangers of self-treatment and investigation. This cross-sectional study was conducted among the undergraduate medical students of US Bangla Medical College (USBMC), Narayangonj from July to December 2022. The study aims to assess the health seeking behavior and self-medication among the students. Data were collected by interviewing students using a pre-designed questionnaire and twenty Likert items were prepared for data collection. Data were analyzed by using SPSS (Statistical Package for the Social Sciences) version 25. Total 293 students were interviewed, among them male - female ratio was 1.23:1 and the age range of the participants was 17 to 28 years. Most of the (70%) students were belonged to upper-middle class family; where 21% from upper class, 8% from lower middle class, and only 1% from the working class family. Regarding the father's educational status of the students more than two-third (69%) of their fathers completed university degree, 29% completed higher secondary or secondary level of education and few (2%) had informal education. Most of the students (81%) used to take medicine without prescription/ self medication. Among the students around one-fourth of them used to take both paracetamol (26%) and painkiller (24%) as self-medication; where 13% of the students used to take antibiotic. Regarding the opinion of the well established definition of ‘Health’ that is “Health includes physical, mental and social well-being and not just absence of disease/ infirmity” most of the students (90%) gave positive statement (agree 58% and strongly agree 32%); where 5% of them were neutral and rest 5% were disagreed. Nearly two-third (65%) of the students expressed their opinion positively (agree 49% and strongly agree 16%) on “seek help immediately when they develop some physical symptoms” that is they seek immediate help for their illness; where 14% of them were neutral and rest 21% were disagreed. More than one-third (35%) of the students stated the reason for self-medication related to their too busy schedule to visit physician and 21% stated that the illness was too minor for consultation; other reasons were knowledge about the drug and illness, follow old prescription, over the counter drugs etc. Almost one-third (30%) of the students opined positively that public health care facilities provide standard health care, but more than one-third (36%) did not comment and rest one-third (34%) differed on it. Remarkably used self-medicated drugs were paracetamol (26%), painkiller (24%), 13% and others NSAIDs/ Analgesics, Antacid/ PPI, Vitamins, antitussive, antihistamines. The statistical test revealed that there is a strong relationship of their opinion on attention to mental physical well-being for healthy lively-hood between coping ability, seek the best care from college hospital and seek help for sensitive matters other than own college hospital (at 5% level of significance). To ensure better health seeking behavior and good practice knowledge of medical students was not absolutely satisfactory. Awareness regarding demerits of self-medication like antibiotics resistance and side effect of drugs would be build among the students. This study would facilitate for increase of medical knowledge and promotion of higher health-seeking behavior. Bangladesh Med J. 2022 Sept; 51(3): 37-42