Health Providers Research Articles

Epistemic injustice, healthcare disparities and the missing pipeline: reflections on the exclusion of disabled scholars from health research

People with disabilities are subject to multiple forms of health-related and wider social disparities; carefully focused research is required to inform more inclusive, safe and effective healthcare practice and policy....

Home-based primary care providers' perspectives on the unique challenges of working with late life posttraumatic stress disorder within their population of Veterans.

Posttraumatic stress disorder (PTSD) is more prevalent in medically ill older Veterans in Home-Based Primary Care (HBPC) settings than in the general population, raising unique considerations. The aim of this qualitative project was to explore HBPC mental health providers' perceptions of the presentation and treatment of PTSD and trauma-related symptoms in this population of older Veterans, many of whom face additional barriers to treatment due to living in rural settings. Five focus groups and one one-on-one interview were conducted with 23 HBPC mental health providers serving rural or rural/urban mixed communities across the United States. We applied qualitative content analysis to the data. Three themes were found: (1) Presentation of Trauma-Related Symptoms and PTSD in HBPC Population; (2) Treatment Challenges in HBPC; and (3) PTSD Treatment Strategies. Each theme had multiple subthemes which illustrate unique issues in this population. Results of this project contribute to key insights surrounding the unique presentation of PTSD and trauma-related processes and treatment considerations in a medically, cognitively, and psychosocially complex group of veterans. Efforts to improve access to care should consider the specific needs of veterans who are homebound, live in rural settings and identify with rural cultural norms, and have difficulty engaging in specialized PTSD treatment due to the convergence of these factors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Rural Appalachian Adolescent Alcohol Misuse and the Triple Threat for Marginalization

Rural Appalachian adolescents are disproportionately affected by alcohol misuse, depression, and mortality rates. Disparities in Appalachia influence national health indicators and the social determinants of health, which may lead to marginalization and vulnerability to poorer health outcomes. Geographic and social isolation often results in missed opportunities for preventative and mental health care. There are an estimated 35% fewer mental health providers in rural areas to deal with these issues. This article examines the influence of marginalization on rural Appalachian adolescents. A case example was used to describe rural Appalachian adolescent alcohol misuse within the context of the Triple Threat for Marginalization, utilizing conversation within a natural setting. Marginalization contributes to alcohol misuse and adverse health outcomes. Nurses must advocate for marginalized rural adolescent patients to decrease alcohol misuse, depression, and mortality rates in this vulnerable population.

Training guidelines and competencies for serious mental illness (SMI) psychology.

Individuals with serious mental illness (SMI) face unique and significant challenges that require evidence-based practices and clinicians who have advanced, comprehensive training to provide them. SMI affects about 5.5% of the U.S. population and results in serious health, social, and economic burdens. Despite advancements in treatment over the past 50 years, training programs for psychologists and other mental health providers have failed to keep up with these advances, underutilizing evidence-based assessments and interventions developed specifically for this population and found to be efficacious. To address this, the SMI Psychology Specialty has developed Training Guidelines to establish consistent, high-quality, and evidence-based training for postdoctoral psychologists. This article highlights selected features of the Training Guidelines for SMI Psychology. Although these were developed for postdoctoral training programs in SMI Psychology, they are applicable to training programs at all levels, and we hope that training programs in psychology and other mental health disciplines will incorporate these advances into their curricula. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adherence with statins and all-cause mortality in days with high temperature.

It has been suggested that statins may exert thermo-protective effects that can reduce mortality on hot days. We aimed to examine the relationship between statin adherence and mortality in days with high temperature. Utilizing data from a prior historical new-user cohort study, we analyzed a cohort of 229 918 individuals within a state-mandated health provider in Israel who initiated statin therapy between 1998 and 2006. Adherence to statins was assessed through the mean proportion of days covered (PDC) with statins during the follow-up period. The study's primary outcome was all-cause mortality during hot days. During the study follow-up period, a total of 13 165 individuals (5.7%) died. In a multivariable model, a 10% increase in PDC with statins was associated with an HR of (0.85; 95% CI: 0.72-1.00) for deaths (n = 16) in extremely hot days (≥39°C). This association was numerically stronger compared to HR = 0.94 (0.93-0.94) in cooler days and displayed a significant difference between sexes. In males, the fully-adjusted HR for a 10% increase in PDC with statins was 0.66 (0.45-0.95), while in women, it was 0.98 (0.78-1.23). In contrast, no such effect modification was observed for death in cooler days. These findings align with earlier research, supporting the notion that adherence with statin treatment may be associated with a reduced risk of death during extremely hot days, particularly among men.

The impact of elder abuse training on subacute health providers and older adults: study protocol for a randomized control trial

BackgroundElder abuse often goes unreported and undetected. Older people may be ashamed, fearful, or otherwise reticent to disclose abuse, and many health providers are not confident in asking about it. In the No More Shame study, we will evaluate a co-designed, multi-component intervention that aims to improve health providers’ recognition, response, and referral of elder abuse.MethodsThis is a single-blinded, pragmatic, cluster randomised controlled trial. Ten subacute hospital sites (i.e. clusters) across Australia will be allocated 1:1, stratified by state to a multi-component intervention comprising a training programme for health providers, implementation of a screening tool and use of site champions, or no additional training or support. Outcomes will be collected at baseline, 4 and 9 months. Our co-primary outcomes are change in health providers’ knowledge of responding to elder abuse and older people’s sense of safety and quality of life. We will include all inpatients at participating sites, aged 65 + (or aged 50 + if Aboriginal or Torres Strait Islander), who are able to provide informed consent and all unit staff who provide direct care to older people; a sample size of at least 92 health providers and 612 older people will provide sufficient power for primary analyses.DiscussionThis will be one of the first trials in the world to evaluate a multi-component elder abuse intervention. If successful, it will provide the most robust evidence base to date for health providers to draw on to create a safe environment for reporting, response, and referral.Trial registrationANZCTR, ACTRN12623000676617p. Registered 22 June 2023.

Education and training of telemental health providers: a systematic review.

To conduct a systematic literature review of education and training (E&T) programs for telemental health (TMH) providers in the past 10 years to qualitatively clarify field offerings and methodologies, as well as identify areas for future growth. We searched five major electronic databases: PubMed, PsycINFO, Scopus, CINAHL, and Web of Science for original publications on TMH E&T from January 2013 to May 2023. We extracted information from each publication and summarized key features of training programs including setting, target group, study aims, training modality, methods of assessing quality, and outcomes. A total of 20 articles were selected for the final review. Articles meeting inclusionary criteria were predominantly comprised of case studies and commentaries, focused on a TMH service/practice for a specific region/population, and were performed after 2020. All of the selected studies demonstrated a significant increase in the measured knowledge, skills, and abilities of the participants after TMH training. Nevertheless, there remains a lack of standardization of training methodologies, limited sample sizes and demographics, variability in study methodologies, and inconsistency of competency targets across studies. This systematic review highlighted the diversity of methods for TMH E&T. Future research on this topic could include more varied and larger-scale studies to further validate and extend current findings, as well as explore potential long-term effects of TMH training programs on both provider attitudes and patient outcomes.

Australian Residential Aged Care Facilities Managers’ and Nurses’ Experiences In Implementing Telehealth and Social Connection During COVID-19

Introduction: Residential aged care facility (RACF) residents are highly vulnerable to severe infection and death from COVID-19. During the pandemic, telehealth (telephone and video) provided a mechanism to deliver for health care and social support. We examined logistical factors associated with telehealth, reasons for its use and barriers associated with the choice of telehealth. Methods: A mixed method exploratory study. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using a hybrid framework approach; deductive analysis followed by inductive analysis for sub-themes. Results: Participants (n=19) reported an increase in telehealth use during COVID-19. Organisations bought new equipment, predominately tablets; half had internet connectivity difficulties; nurses used personal devices to overcome connectivity issues or inadequate devices and 74% used three or more platforms/software. Few residents had personal digital devices or could connect with family and friends alone. Five key sub-themes emerged from qualitative data. 1. Needing and persisting with telehealth. RACFs had limited video telehealth use before COVID-19. 2. Being dependent on health providers offering telehealth services. Telehealth was used for a broad range of services. However, many health providers did not offer telehealth consultations. 3 Residents living with dementia. Telehealth was suitable for residents with dementia, depending on the disease stage and clinical need. 4. Challenges with implementing telehealth consultations. Most challenges pertained to workflows. 5. Suitability of videoconferencing for social connection. Staff supported residents with video calls which were highly valued. Conclusion: To capitalise on and sustain telehealth activity in RACFs, further guidance and support to overcome operational barriers are required.

The inequity of education, health and care plan provision for children and young people with intellectual and developmental disabilities.

Children and young people (CYP) with intellectual and developmental disabilities (IDDs) have significant additional educational needs compared with the general population. In England, the government has established a system of education, health and care plans (EHCPs) to support children with special educational needs and disabilities, but disparities exist between the degree of need and the availability of support. We conducted a prospective UK national cohort study (IMAGINE) of children with rare pathogenic genomic variants, all of which are associated with IDD, to investigate associated neuropsychiatric risk. Subsequently, we obtained information from the UK's National Pupil Database on their educational progress through the state school system. We aimed to identify whether they had received EHCP provision and whether that support was associated with their family's socioeconomic status, region of domicile, ethnicity, sex, primary special educational needs (SEN) type, academic performance and mental health well-being. We recruited 2738 CYP from England into the IMAGINE study between 2014 and 2019. The educational histories of the participants (6-28years old, mean±standard deviation= 14±4years, 56% male) were obtained from the Department for Education's National Pupil Database in 2021. Educational data included attainment scores from the Early Year Foundation Stage (<5years) to key stage 4 (15-16years). Each family was assigned an index of multiple deprivation (IMD) score based on their home address postcode. Parents or carers rated their child's emotional and behavioural adjustment on the Strengths and Difficulties Questionnaire (SDQ). The association between receiving an EHCP and the child's IMD score, eligibility for free school meals, English region of domicile, ethnicity, sex, primary SEN type, academic attainment and SDQ score was investigated. In this cohort, 78% of participants had received an EHCP. CYP living in the most deprived IMD deciles were substantially less likely to receive EHCP support than those in the least deprived decile, irrespective of their degree of intellectual developmental disability, academic performance or associated mental health problems. There were no sex differences. Children of Asian heritage were more likely to have been granted an EHCP than White children from equivalent IMD deciles. There were striking regional disparities. Participants living in London were significantly more likely to have been awarded an EHCP than participants living anywhere else in England, regardless of their IMD decile; those in the least deprived decile had almost 100% EHCP provision. This study found evidence for nationwide regional inconsistencies in the awarding of EHCP to CYP with significant intellectual impairments of known genetic aetiology. Disparities in funds available to education authorities could be a contributory factor. EHCP support was potentially influenced by how strongly a parent advocates for their child.

Navigating Client Deaths in the Community Mental Health Center: A Humanistic Approach to Clinical Supervision

Mental health providers in community mental health centers (CMHCs) often contend with patient deaths but there is little established guidance in the literature in regard to clinical supervision following these losses in general, and making meaning of these experiences specifically. Following a brief review of relevant literature, the authors offer four identified challenges to a meaning-making supervisory approach. Namely, these are (a) determining a supervisory response, (b) disenfranchisement of grief in professionals, (c) a hyperfocus on quantifiable outcomes, and (d) an outsized focus on risk response. The authors contend that a humanistically-oriented, meaning-making response guided by the recovery model provides answers to these challenges, and present a case study demonstrating how these have been navigated in a CMHC.

Assessing climate change and health provisions among staff in higher education institutions: A preliminary investigation.

Climate change can have direct and indirect effects on human health. Direct effects can include an increase in extreme weather events, such as heatwaves and floods, as well as an increase in the spread of vector-borne and infectious diseases, which may lead to a set of health problems and diseases. Indirect effects can include changes in air quality, water availability, and food production and distribution. These changes can lead to an increase in respiratory problems, malnutrition, and increased food insecurity. There is a perceived need to investigate the extent to which Higher Education Institutions (HEIs) are engaged in efforts to foster a greater understanding of the connections between climate change and health. In this context, this preliminary investigation offers an overview of the relationships between climate change and health. By means of a survey among teaching staff and researchers at HEIs from 42 countries across all continents working on the connection between climate change and health. The study has investigated the extent to which current provisions for education and training on the connection between climate change and health are being considered and how current needs in terms of policy development, research, and training are being met. A series of case studies illustrate how universities worldwide are actively developing strategies and implementing measures to address climate change and health. The study concludes by providing specific recommendations aimed at facilitating the handling of issues related to climate change and health in a higher education context.

Mobilizing stakeholders for implant removals in Burkina Faso using landscape assessment data

BackgroundSuccessful efforts to encourage uptake of subdermal contraceptive implants, with a lifespan of three to five years, necessitate planning to ensure that quality removal services are available when desired. In Burkina Faso, implant use has tripled over the past 8 years and now comprises almost half of the contraceptive method mix. Population Monitoring for Action (PMA) surveys identified barriers to obtaining quality removal when desired, particularly when the implant is not palpable, or providers lack needed skills or supplies. The Expanding Family Planning Choices (EFPC) project supported ministries of health in four countries with evaluation and strengthening of implant removal services.MethodsAn implant removal landscape assessment was conducted at 24 health facilities in three regions of Burkina Faso with high implant use that included provider observations of implant removal, interviews with providers and health facility managers, and facility readiness surveys. The project used landscape data to mobilize stakeholders through a series of participatory workshops to develop a collaborative roadmap and commit to actions supporting quality implant removals.ResultsLandscape findings revealed key gaps in provision of quality removal services, including high levels of provider confidence for implant insertion and removal (82% and 71%, respectively), low competence performing simple and difficult removals (19.2% and 11.1%, respectively), inadequate supplies and equipment (no facilities had all necessary materials for removal), lack of difficult removal management systems, and a lack of standard data collection tools for removal. Exposure to the data convinced stakeholders to focus on removals rather than expanding insertion services. While not all roadmap commitments were achieved, the process led to critical investments in quality implant removals.ConclusionLandscape data revealed that facilities lack needed supplies and equipment, and providers lack skills needed to perform quality implant removals, limiting client reproductive choice. Disseminating this data enabled stakeholders to identify and commit to evidence-based priority actions. Stakeholders have since capitalized on program learnings and the roadmap, including following MOH guidance for implant removal supplies and health provider training. Our experience in Burkina Faso offers a replicable model of how data can direct collective action to improve quality of contraceptive implant removals.

LONG-TERM EFFECTS OF COVID-19

The COVID-19 pandemic has been a defining global event, impacting nearly every aspect of life worldwide. This paper presents a review of the long-term effects of COVID-19, focusing on the impacts on people’s physical and mental health. It synthesizes current knowledge from different studies, articles, analyses, and case reports to provide a comprehensive understanding of the prolonged physical, psychological and socioeconomic consequences of COVID-19. The virus has prolonged effects on various organ systems in human body especially in individuals who experienced severe cases or complications, as well as profound psychological impact. Efforts to address the physical and mental consequences of COVID-19 require a comprehensive approach involving healthcare professionals, mental health providers, policymakers, community organizations, and individuals themselves.

Форми медичного контролю на заняттях силової направленості

Medical control is a scientific and practical branch of medicine that studies the issues of physical development, functional state, and health of the human body during physical exercises and sports. The purpose of medical control is to promote the effectiveness of the physical education process in every way, the correct use of physical culture tools. Medical control is a mandatory condition for injury prevention, preservation of human health, longevity, and creative activity. The main tasks of medical control: determining the state of health and solving issues of admission to classes in various forms and groups; carrying out medical control at physical education and sports classes; diagnostics of the functional state; assessment of physical development and identification of diseases and injuries; medical provision of competitions; agitation and promotion of physical culture among the population. Forms of medical control: regular medical examinations and control of persons engaged in physical exercises and sports; medical and pedagogical observations of people who are engaged in classes and competitions; sanitary and hygienic control over the places and conditions of classes; medical and sanitary provision of mass health and sports events (in sports camps and at educational and training meetings);prevention of sports injuries and diseases; sanitary and educational work and promotion of physical culture, sports, a healthier lifestyle. Physical development is assessed using anthropometric measurements, as well as the method of questioning and external examination. Anthropometric measurements make it possible to determine the level and features of physical development, the degree of conformity to gender and age.

Factors associated with hepatitis B knowledge among people of Vietnamese ethnicity in Australia

ABSTRACT Despite high hepatitis B (HBV) prevalence among people of Vietnamese ethnicity in Australia and elsewhere, there is limited research on levels of HBV knowledge and factors associated with such knowledge. The aim of this study was to examine HBV knowledge and associated demographic and attitudinal factors among people of Vietnamese ethnicity in Australia. People of Vietnamese ethnicity (n = 966) were recruited through community events and social media groups to complete online surveys measuring HBV knowledge, attitudes towards HBV, levels of mistrust in Western medicine, and demographic characteristics. Findings of this study indicate that levels of knowledge are mixed, with gaps in knowledge related to transmission and treatment of the virus. Those with greater knowledge of HBV tended to be older, have higher levels of formal education, have been tested for HBV, and know someone living with HBV. Those with lower levels of knowledge tended to have more negative attitudes towards the virus and greater levels of mistrust in Western medicine. Given that health literacy is connected to effective communication from health providers, we suggest that there is a need for the development of health promotion and education resources targeted at people of Vietnamese ethnicity and translated into Vietnamese. We propose that such resources be developed in consultation with Vietnamese communities and health providers to ensure that they are culturally appropriate and sensitive to people of Vietnamese ethnicity living in Australia.

A framework to guide oral healthcare at long-term care facilities in the eThekwini district

Oral healthcare is an important aspect of the general healthcare of individuals residing in long-term care (LTC) facilities. However, it is often neglected in these settings and contributes to oral health disparities and oral diseases among residents. The World Health Organization promotes the reduction of health disparities and diseases through health promotion as an ethical obligation. The utilization of frameworks to promote oral health provides a structured approach to the design, implementation, and evaluation of oral health promotion programs. This study proposed a framework to guide the development, implementation, and review of an oral health promotion intervention, so as to ensure that a systematic and evidence-based approach is used for the delivery of oral health promotion activities. The framework comprised three stages: needs analysis, implementation and review of an oral health intervention, which was guided by the Precede-Proceed model and Intervention mapping. The empirical aspect involved a 4-phased mixed method exploratory study, based on action research and the plan-act-observe-reflect cycle, which illustrated how the framework was operationalized. The oral health intervention indicated positive outcomes with regard to knowledge and attitudes among caregivers. ConclusionThe framework incorporated the key components that influenced oral health provision at LTC facilities.

Use of digital technologies for staff education and training programmes on newborn resuscitation and complication management: a scoping review

BackgroundPoor-quality care is linked to higher rates of neonatal mortality in low-income and middle-income countries (LMICs). Limited educational and upskilling opportunities for healthcare professionals, particularly those who work in remote...

Assessing Tobacco Treatment Engagement in Assertive Community Treatment Programs.

Despite high tobacco use prevalence among those with serious mental illnesses, few Assertive Community Treatment (ACT) programs provide tobacco treatment. Understanding the factors associated with the intentions to engage in tobacco treatment from both provider and consumer perspectives is important. The purpose was to examine ACT providers' intention to provide and consumer intention to engage in tobacco treatment. A cross-sectional survey of ACT program providers (N = 51) and consumers (N = 43) from four community mental health centers. Multiple linear regression analyses were used to examine factors associated with the intentions to provide or engage in tobacco treatment from among attitudinal, subjective norms, and perceived behavioral control variables. Providers reported positive attitudes, high degree of perceived behavior control, and high intentions for delivering tobacco treatment, but poor perceptions of subjective norms. These results were like consumers' intentions to engage in tobacco treatment. In regression analysis, only subjective norms and perceived behavior control were significant predictors for providers' intentions to provide tobacco treatment, but there were no significant predictors of consumers' intentions to engage in tobacco treatment. Both providers and consumers endorsed poor implementation of evidence-based tobacco treatment. Poor engagement in tobacco treatment within ACT programs indicates the need for policymakers to support tobacco treatment within the services. This finding calls for training of mental and behavioral health providers while supporting tobacco-free initiatives in ACT treatment service settings.

Examining the promotion of mental health and wellbeing in Australian sports clubs

ABSTRACT Organised sport is increasingly recognised as a culturally acceptable site for mental health and wellbeing promotion. To date, however, there is limited knowledge pertaining to how exactly mental health and wellbeing is supported in such contexts. The present study aimed to provide insight into mental health and wellbeing promotion practices in Australian sports clubs. An online cross-sectional survey examined the current provision of mental health and wellbeing initiatives in sports clubs, barriers and motives to such promotional efforts, and perceptions of psychological safety within club environments. The survey was completed by 302 stakeholders of Australian sports clubs (Mage = 41.3 ± 15.7 years, 46.7% male). Fewer than half of stakeholders (47.7%) reported that their sports club had implemented initiatives to support mental health and wellbeing. Insufficient resources (e.g. knowledge, finances) were identified as the most prominent barrier to such promotional efforts. Sports clubs reported using various initiatives to promote mental health and wellbeing, although evidence-based resources (e.g. Ahead of the Game) were rarely implemented. Stakeholders in sports clubs that had implemented initiatives to support mental health and wellbeing perceived their club as a more mentally healthy environment and attained higher mental health literacy scores. Ongoing efforts to increase the utilisation of sports settings to support mental health and wellbeing are necessary.

Use of digital media by adolescents for sexual and reproductive health and rights communication in sub-Saharan Africa: a protocol for systematic review

BackgroundWithin the sub-Saharan African region, there is a growing concern for sexual and reproductive health and rights communication, and more particularly, for adolescents. Given the existing barriers associated with face-to-face access, the need to use digital media to access information and services has become desirable and imperative, especially so due to the COVID-19 pandemic. However, in sub-Saharan Africa, a synthesis of evidence that informs adolescents’ digital media engagements for sexual and reproductive health and rights (SRHR) communication is limited. This systematic review therefore aims to examine and synthesize evidence on use of digital media for sexual and reproductive health and rights communication by adolescents in sub-Saharan Africa.MethodsA search for peer-reviewed articles will be conducted in PubMed, ScienceDirect, Scopus, Embase, Web of Science, PsychINFO and Google Scholar with emphasis on those published between 2000 and 2023. Only observational and qualitative studies will be included. Quality assessment of included articles will be done using standardized checklists from the Joanna Briggs Institute. Both descriptive and narrative summaries will be used to appraise evidence from included studies.DiscussionThis review will be essential in providing information on the types of digital media adolescents use, the various SRHR issues they use this platform to address and their reasons for using it and associated challenges. It will also contribute to the advocacy for the inclusion of these technologies in the teaching and learning, provision of and access to SRHR information and services by teachers, public health providers and peer educators in the subregion.Systematic review registrationPROSPERO CRD42020211491. This protocol follows the PRISMA-P guidelines for reporting systematic reviews.