Illness In People Research Articles

Self-help Digital Interventions Targeted at Improving Psychological Well-being in Young People With Perceived or Clinically Diagnosed Reduced Well-being: Systematic Review.

BackgroundLevels of well-being are declining, whereas rates of mental health problems remain high in young people. The World Health Organization defines mental health as not merely the absence of mental disorder but also includes social and psychological well-being as integral to positive mental health, highlighting that mental health is applicable to young people with mental health conditions and those without a diagnosis of a mental health condition. Reduced mental well-being have been identified in studies of young people with clinical populations, as well as in populations consisting of nonclinical young people. Self-help digital interventions can be delivered at mass at a low cost and without the need for trained input, thereby facilitating access to support for well-being. Self-help interventions are effective in young people with mental health conditions, but systematic reviews of such studies have been limited to randomized controlled trials, have not included reduced well-being as an inclusion criterion, and do not consider engagement factors such as retention.ObjectiveThe objective of this study was to systematically review all controlled studies of digitally delivered, self-administered interventions for young people aged 9 to 25 years, with perceived or clinically diagnosed reduced psychological well-being. Participant retention and effectiveness of the interventions were also explored.MethodsA systematic search of the PsycInfo, EMBASE, Cochrane, Scopus, and MEDLINE databases from inception to 2021, reference searches of relevant papers, and gray literature was carried out for digitally controlled studies conducted with young people with perceived or clinically diagnosed reduced well-being, aimed at improving psychological well-being. Data were extracted to identify the effectiveness and retention rates of the interventions and the quality of the studies.ResultsOverall, 1.04% (12/1153) of studies met the inclusion criteria: 83% (10/12) of studies were randomized controlled trials and 17% (2/12) were controlled pre-post studies. Most (6/12, 50%) studies aimed to improve symptoms of depression; 3 interventions aimed at both anxiety and depressive symptoms and 2 studies aimed at improving social functioning difficulties. Owing to the high risk of bias across interventions and lack of similar outcome measures, a meta-analysis was not conducted. Retention rates across studies were regarded as good, with moderate to high retention. Overall, the findings indicated that predominantly self-administered self-help interventions improved well-being in the areas targeted by the intervention and identified additional areas of well-being that were positively affected by interventions. Few interventions supported psychological well-being that was different from those used by young people with a clinical diagnosis of mental illness or young people from neurodiverse backgrounds.ConclusionsThe findings, along with the advantages of self-help interventions, highlight the need for upscaling self-help interventions to better support vulnerable populations of young people who experience poor psychological well-being.Trial RegistrationPROSPERO CRD42019129321; https://tinyurl.com/4fb2t4fz

The Function of Occupational Activity for Health as Perceived by Chronically Ill People.

Existing studies confirm the benefits of employment for chronically ill persons’ health, but few studies so far have delved into how they themselves perceive employment in relation to their health. There is also a paucity of information about individual factors influencing the formation of their perceptions. This study sought to determine differences between chronically ill persons with and without jobs regarding their perceptions of the function of employment for the physical, mental and social dimensions of health, as well as how their occupational activity or inactivity moderates the associations between the perception of work as health beneficial or health adverse and selected individual characteristics, such as self-efficacy, acceptance of illness, actualisation of self, and psychosocial problems. The study involved 80 adults with chronic illnesses and was conducted using the following psychological tools: the WH Scale, the Generalized Self-Efficacy Scale, the Acceptance of Illness Scale, the Actualization of Self Scale and the Psychosocial Problems of Persons with Chronic Illness Scale. It has been found that the way in which chronically ill persons perceive the function of employment for health is unrelated to whether or not they have a job, and that occupational activity moderates associations between the sense of self-efficacy and the perception of work as benefitting health.

Patient Science: Citizen Science Involving Chronically Ill People as Co-Researchers

Citizen science projects in health-related research usually follow a crowdsourcing approach where laypersons primarily have a supplying role in data collection. By contrast, this article presents an approach on a much higher engagement level (co-creation) where a team of professional and citizen scientists jointly plans, implements, and evaluates a scientific study on a chronic disease from which the citizen (patient) scientists themselves suffer. We call this approach patient science; it systematically makes use of the patients’ expertise of living with the disease. This article describes the pilot project and conceptual differences compared to other participatory approaches in medical and health research. It elaborates on the implications of involving chronically ill people as co-researchers and, finally, reflects on the benefits and challenges of patient science.

Stigmatization by Nurses towards Mentally Ill People

Background:People with mental illness face two major problems at the same time. The first is the disease itself which they must learn to live with and to manage all its symptoms. The second, often more serious problem, is the presence of stereotypes and prejudices which are the result of insufficient knowledge about mental illnesses and their misunderstanding. The aim was to explore the current state of stigmatization by nurses towards mentally ill people. Methods: In this quantitative exploratory research we used an existing questionnaire (the Opening Minds Scale for Health Care Providers) with randomly selected nurses who treat mentally ill patients. Results:A significant difference in the degree of stigmatization with respect to the age of the nurses was not found. However,in terms of the overall assessment, specifically in the domain of attitudes, the rate of stigmatization was higher among younger respondents. Nurses with shorter professional experience proved a lower degree of stigmatization than nurses with longer professional experience. Conclusion: It is expected that the rate of mental illnesses will increase. Therefore, we recommend continuing to pay increased attention to destigmatization within the education of and developing more destigmatizing initiatives among nurses.

Multistate outbreak of Salmonella Mbandaka infections linked to sweetened puffed wheat cereal - United States, 2018.

In May of 2018, PulseNet, the national molecular subtyping network for enteric pathogens, detected a multistate cluster of illnesses caused by an uncommon molecular subtype of Salmonella serovar Mbandaka. A case was defined as an illness in a person infected with the outbreak strain of Salmonella Mbandaka with illness onset on or after 3 March 2018 and before 1 September 2018. One-hundred thirty-six cases from 36 states were identified; 35 hospitalisations and no deaths were reported. Ill people ranged in age from <1 year to 95 years (median: 57 years). When standardised questionnaires did not generate a strong hypothesis, opened-ended interviews were performed. Sixty-three of 84 (75%) ultimately reported consuming or possibly consuming a specific sweetened puffed wheat cereal in the week before illness onset. Environmental sampling performed at the cereal manufacturing facility yielded the outbreak strain. The outbreak strain was also isolated from open cereal samples from ill people's homes and from a sealed retail sample. Due to these findings, the brand owner of the product issued a voluntary recall of the cereal on 14 June 2018. Additional investigation of the manufacturing facility identified persistent environmental contamination with Salmonella Mbandaka that was closely genetically related to other isolates in the outbreak. This investigation highlights the ability of Salmonella to survive in low-moisture environments, and the potential for prolonged outbreaks linked to products with long shelf lives and large distribution areas.

A Study of the Attitudes towards Mentally Ill People among a Sample of Primary Health Care Physicians in Saudi Arabia

Background: Psychiatric illnesses are a public health problem worldwide, affecting people of all age. Mental health is an important sector of primary health care services. An increasing number of Saudi citizens and residents utilize primary healthcare services for mental health concerns; hence, there is a need to objectively assess these doctors' attitudes towards people with mental illness.&#x0D; Objectives: Assessment of the attitudes toward mentally ill people among a sample of primary health care physicians in Saudi Arabia &amp; determination of risk factors associated with bad attitudes.&#x0D; Methods: A cross-sectional study was conducted over a period of 30 days (1st September 2021 to 30 September 2021). The study has been conducted on Convenient Sample of Arabic speaking physicians working in primary health care centers in Saudi Arabia who accepted to share in research. Demographic Data was gathered using an electronic self‑administered questionnaire and physicians’ attitudes towards mentally ill people have been evaluated by an Arabic previously validated Questionnaire.&#x0D; Results: This study included 214 physicians, 114 male physicians and 100 females. 72% of participants have a highly positive attitude toward mentally ill patients with a mean score (50±4) and only 28% of participants have a negative attitude with a mean score (38±4). Better attitudes were significantly associated with being female, having (Board, PhD or Fellowship), working for less than a year and having a history of involvement in the care of a mentally ill person. There were no statistically significant differences regarding participants age, nationality, marital status, place and mode of residency, specialty, and having current or past history of mental illness.&#x0D; Conclusions: Primary health care physicians in Saudi Arabia have positive attitudes toward mentally ill patients, female physicians , having (Board, PhD or Fellowship), working for less than a year and having a history of involvement in the care of a mentally ill person were significantly associated with better attitudes.&#x0D; Recommendations: Further larger studies are needed on large number of primary health care centers physicians in Saudi Arabia and other Arab countries. Additional research and programmatic work are needed to understand the reasons for negative attitudes. Effective teaching and training programs is necessary to bring in positive attitude change towards mentally ill people among primary health care physicians.

An investigation protocol to manage a foodborne outbreak in a disaster event

Abstract Background During disaster events, the displaced populations living in tent camps are at high risk from foodborne illness outbreaks (FBO) as in these circumstances it is difficult to follow proper hygienic procedures during food handling and storage. When an outbreak occurs, an epidemiological investigation able to identify the source(s) of the exposure is essential to rapidly establish control measures to prevent continuing episodes of illness. This work aimed to evaluate the effectiveness and the applicability under simulated field conditions of an investigation protocol to be used during a FBO. Moreover, the application of the software ‘TOSSINFO' for data analysis was evaluated. Methods In May 2018, a FBO associated with the consumption of a tuna affecting 46 out of 75 people present in a tent camp in southern Italy was simulated. During the simulation, two teams of doctors and veterinarians participated in the investigation. The investigation protocol involved three steps: environmental inspection, epidemiological investigation, and data analysis through TOSSINFO. This software allows calculating different epidemiological indicators, several measures of association, and the visualization of the progression of the outbreak through epidemic curves. Results At the end of the exercise, both teams were able to trace the source of the infection. After data collection and data analysis, the groups demonstrated a strong association between illness people and tuna consumption. Furthermore, the teams achieved similar Results RR (7.50 vs 7.01), OR (27 vs 28), and Chi-square (12.1 vs 10.1). Conclusions The results demonstrated the validity of the procedure and the simple execution of the software analysis. These guidelines represent an opportunity for the implementation of foodborne disease management strategies and could be used throughout the community, leading to an improvement of the Public Health surveillance system. Key messages These guidelines allow for effective management of a food toxinfection episode. The original software TOSSINFO used in this procedure enables quick and easy identification of infected food.

Unsupervised Deep Learning based Variational Autoencoder Model for COVID-19 Diagnosis and Classification.

At present times, COVID-19 has become a global illness and infected people has increased exponentially and it is difficult to control due to the non-availability of large quantity of testing kits. Artificial intelligence (AI) techniques including machine learning (ML), deep learning (DL), and computer vision (CV) approaches find useful for the recognition, analysis, and prediction of COVID-19. Several ML and DL techniques are trained to resolve the supervised learning issue. At the same time, the potential measure of the unsupervised learning technique is quite high. Therefore, unsupervised learning techniques can be designed in the existing DL models for proficient COVID-19 prediction. In this view, this paper introduces a novel unsupervised DL based variational autoencoder (UDL-VAE) model for COVID-19 detection and classification. The UDL-VAE model involved adaptive Wiener filtering (AWF) based preprocessing technique to enhance the image quality. Besides, Inception v4 with Adagrad technique is employed as a feature extractor and unsupervised VAE model is applied for the classification process. In order to verify the superior diagnostic performance of the UDL-VAE model, a set of experimentation was carried out to highlight the effective outcome of the UDL-VAE model. The obtained experimental values showcased the effectual results of the UDL-VAE model with the higher accuracy of 0.987 and 0.992 on the binary and multiple classes respectively.

Tri-Response Police, Ambulance, Mental Health Crisis Models in Reducing Involuntary Detentions of Mentally Ill People: Protocol for a Systematic Review.

Police, ambulance and mental health tri-response services are a relatively new model of responding to people experiencing mental health crisis in the community, but limited evidence exists examining their efficacy. To date there have been no systematic reviews that have examined the association between the tri-response model and rates of involuntary detentions. A systematic review examining co-response models demonstrated possible reduction in involuntary detention, however, recommended further research. The aim of this protocol is to describe how we will systematically review the evidence base around the relationship of the police, ambulance mental health tri-response models in reducing involuntary detentions. We will search health, policing and grey literature databases and include clinical evaluations of any design. Risk of bias will be determined using the Effective Public Health Practice Project Quality Assessment Tool and a narrative synthesis will be undertaken to synthesis key themes. Risk of bias and extracted data will be summarized in tables and results synthesis tabulated to identify patterns within the included studies. The findings will inform future research into the effectiveness of tri-response police, ambulance, and mental health models in reducing involuntary detentions.

Investigation of the Changes in the Physical Parameters of Fitness Members During the Covid-19 Pandemic Process (Sample Province of Kayseri)

Background: The period of Covid 19 epidemic effect not only illness people but also human lives. A lot of People, participating some of activities in gym center from Kayseri. Some of restraint during the covid 19 epidemic by the ministry of interior was affected people who went to fitness center. This situation affected people of Body Weight, Body Mass Index, Body Fat Index unfavorable. Aim: The purpose of this study was to determine the physical changes of the participants who actively attended fitness centers during the Covid-19 pandemic. Aim: The purpose of this study was to determine the physical changes of the participants who actively attended fitness centers during the Covid-19 pandemic. Methods: In this study, 211 participants (male:155, female:56) enrolled in fitness centers in the experimental group were checked for 2 months and their Body Weight (BW), Body Mass Index (BMI), Body Fat Index (BFI) and were recorded twice. The findings obtained were evaluated statistically with the package program Results: In our study, n=55 over the age of 18, 26.1% were female; n=156, 73.9% of the male individuals voluntarily participated. At the end of the study, it was found that there was an increase in BW, BMI and BFI values of male and female participants and that they were significant at the level of paired sample t test findings (p&lt;0.05). Although there was an increase in MMI values, these findings were found to be at the level of (p&gt;0.05). Conclusion: At the end of the research, it was found that individuals who actively continued in fitness centers during the Covid-19 pandemic in Kayseri province experienced restrictions and an increase in BW, BMI, and BFI due to sedentary life. Keywords: Covid 19 Restriction, Physical Parameter, Fitness Center

The system of personal values in the life of oncologically ill youths

Personal values in a neoplastic disease have been the subject of numerous psychological studies. The study presented here shows differences in personal values selected by oncologically ill youths (50 people) and healthy youths (40 people), aged 18-20. Results reveal that the value of good health constitutes the most essential difference between the ill/healthy groups. Chronic diseases are diagnosed in people of all ages. Some are flowing smoothly, others are stormy. Some last from birth, others appear unexpectedly at different times of life. The disease violates the spiritual and mental order, because the patients can’t meet their needs, desires, dreams, plans as much as they would like. They are experiencing anxiety, depression, irritability, emptiness and other emotional states. The medical literature defines long-term illnesses as permanent, irreversible, progressive changes that cause damage to the system, permanently reducing its effectiveness and productivity, mainly in acute and chronic conditions, as the same long-term pathological process. Favorite work, profession and successful family life are the most significant values for ill people. Ill people choose the mentioned values more frequently than healthy people. This result is a rebuttal of the assumptions made, so it should be noted that it may be a consequence of the activation of the safeguards (in particular the objection), and it is generally a plausible and expected fact. It would be worthwhile in future research to extend the study group in order to verify and compare the findings.The results can also be influenced by the choice of subjects, their age, stage of treatment, specific cancer, such as bone cancer, too small research group and others. In the future, to test and compare the results, it is worthwhile to prepare a retest and increase the number of subjects, to introduce groups of subjects with other cancers, and to pay attention to the age, emotions and treatment stage of the patients being studied.

Perception of Own Illness and Trust in Medical Personnel among Chronically Ill People

Appropriate perceptions of own disease by chronically ill person significantly affects the success of the diagnostic and therapeutic process. It depends on the existential situation of the patient, the adopted strategy of coping with the disease, received social support, as well as on the way the patient is treated by medical personnel. The aim of the conducted research was to assess the relationship between the perception of the disease by chronically ill people and their trust in medical staff.&#x0D; &#x0D; The study involved 511 people receiving treatment for chronic diseases. The diagnostic survey method was used in the study, the research tools were: the Imagination and Perception of Illness Scale (IPIS), the Brief Illness Perception Questionnaire (Brief IPQ), the Trust in Physician scale by L.A. Anderson and R.F. Dedrick, and a self-authorship questionnaire.&#x0D; &#x0D; Among the studied population, statistically significant relationships were observed between the perception of own disease by the patient, measured with the IPIS scale, and the trust in medical personnel calculated with the Trust in Physician. In the study group, there are statistically significant differences between the belief of the respondents in the effectiveness of treating their own disease and the overall result of trust in medical personnel.&#x0D; &#x0D; The perception of own disease by chronically ill people affects the level of trust in medical staff. The way the patients will perceive their illness depends, among other things, on the relationship between them and the doctor.

Factors Associated with Prolonged Institutionalization in Mentally Ill People with and Without a History of Violence and Legal Involvement: A Cross-Sectional Study.

This is a cross-sectional study carried out on 34 individuals hospitalized for a long period in the Federal District, in Brazil. To evaluate factors related to prolonged institutionalization in mental patients with history of violence and criminal records. Individuals found were assorted into two groups: with and without criminal records. We analyzed 56 items by reviewing medical records and health records. Demographic and social data, history of violence, criminal involvement, medical history, substance use, and other aspects related to long hospitalizations, by reviewing medical and health records. We found a profile of male individuals: single, male, with an average age of 47.6 years, low education, and little professional qualification from correctional facilities or long-term psychiatric clinics and hospitals. Most men had a history of aggressive behavior, a leading psychiatric diagnosis of psychosis, and an issue with polypharmacy. Two factors showed statistical significance and were highly related to longer institutionalizations: polypharmacy and records of hospitalization for violent behavior. Further studies with these populations are needed to increase knowledge on the subject. They can help health care systems to improve and provide broad, humanized and quality assistance with multi-professional teams, aiming to reduce prolonged hospitalizations.

Is it normal to be depressed in old age? Needs assessors' conceptions of older people's mental illness.

The article contributes to the research on older people's mental illness through its focus on how needs assessors conceive mental illness amongst older people and their strategies for dealing with mental illness within existing organisational frameworks. The contribution is based on an empirical study of the needs assessment in eldercare in Sweden. The article aims to explore needs assessors' conceptions of mental illness amongst older people in relation to intertwining processes of normalisation and organisational and legal constraints. The normalisation principle (NP) proposes that individuals with a disability should have access to the same living conditions as 'others'. The NP can be described as a strategy that highlights equal rights for individuals regardless of their life situation. The main findings are that mental illness is defined by needs assessors on a spectrum of diagnoses from schizophrenia and borderline personality disorder to anxiety and depression. The successful normalisation of mental illness is linked to structural context, attitudes to older people's mental illnesses and ageing, the practise established on a unit and whether needs assessors reproduce ageism or challenge it through the NP by attempting to secure the rights of older people.

Diversity in Representations and Voices of Terminally Ill People in End-of-Life Documentaries.

Background: The 21st century has seen a proliferation of end-of-life documentary films and television documentaries that contribute to building a public image of hospice and palliative care. The way in which terminally ill patients are represented in these documentaries creates impressions of who is welcomed to receive end-of-life care. These documentary representations have not been previously mapped. Methods: Using quantitative content analysis, I analyzed 35 contemporary Western documentaries and studied their diversity in the representations. I focused on terminally ill patients who are given time and space in the narration to voice their views about the end-of-life process. I paid attention to such elements as gender, race and ethnicity, age, class, religion and sexuality. Results: The documentaries welcomed the representations and voices of terminally ill people. Class, religion and sexuality often had a marginal role in narration. The gender diversity of the representations was quite balanced. Regarding age, the documentaries preferred stories about working age patients for dramatic purposes, yet all age groups were represented. However, the documentaries had an identifiable racial and ethnic bias. With a few exceptions, terminally ill who had a personal voice in the narrations were white. In comparison, racial and ethnic minorities were either absent from most of the documentaries, or their role was limited to illustrations of the general story. Conclusions: End-of-life documentaries provide identifiable access to the patients’ experiences and as such they provide emotionally and personally engaging knowledge about hospice and palliative care. While these representations are people-oriented, they include racial disparities and they focus mostly on the experiences of white terminally ill patients. This bias reinforces the misleading image of hospice and palliative care as a racialized healthcare service.

Attitudes of primary care physicians toward patients with mental illness in Medina, Saudi Arabia

Background: Personal attitudes and beliefs toward mental illness set the stage for how they interact with mental illness people, provide opportunities, and support a person with mental illness. Attitudes and beliefs about mental illness are shaped by personal knowledge about mental illness, interacting or knowing someone with mental illness, and cultural pattern about mental illness. The general population tends to choose primary care physicians as their entry point to mental care. The present study was aimed at assessing the attitudes of primary care physicians towards patients with mental illness in Medina, Saudi Arabia. Methodology: A cross-sectional study was carried out. The study population included all primary health care center (PHC) consultants, specialists, and family medicine residents in Madinah, Saudi Arabia. A total of 41 PHC practice sites were involved. The study tool comprised of three main sections using the Social Distance Scale and Dangerousness Scale. Result: The number of individuals who cooperated with the study and responded to the research application were 134 doctors. Majority of them (51.5%) were males, the study show there were no significant differences of the attitudes among the primary care physicians based on gender, country of origin, medical degree, years of experience, and no significant differences were observed in the dangerousness scale by age group but show substantial differences in the Social Distance Scale by age group. Conclusions: In conclusion, the attitudinal level of primary care physicians toward patients with mental illness in Saudi Arabia was acceptable, and authors strongly recommend the need of future educational involvement and interventions.

Role of Anxiety and Depression in Altering Immune System Associated with Breast Cancer. Systematic Review

Background: Focusing on basic and clinical research, psycho-neuroimmunology researchers are looking at how the factors that cause anxiety and depression and their negative emotions can affect physiological and health conditions. Clinical studies have shown that the central nervous system is associated with endocrine and immune systems. Objectives: To investigate the impact of depression and anxiety on developing breast cancer through immune disturbance pathway Methodology: The present study is a descriptive review of systematic review studies conducted in accordance with the guidelines for preferred cases for reporting systematic and metaanalysis review articles (prisma). Electronic databases including ISI Web of Knowledge, PubMed, and Scopus, were searched from 2012 to 2020. The search strategy psychological, immune response, anxiety disorder, depression, and psychoneuroimmunology. Additionally, we searched the references of retrieved articles to find additional included a combination of the following Medical Subjects Headings (MeSH) terms: breast cancer, potentially related studies. We have considered herbal therapies, which were applied orally, or topically.The content of all articles was evaluated qualitatively after extracting from the desired databases with PRISMA checklist. Results: the impact of psychological problems on people's illness is very large, when people have a lot of psychological pressure, the incidence will be higher than ordinary people.Health Psychology considers human health to be a complex entity and believes that disease is not caused by a single factor but is the product of biological, psychological, and social factors. Recent research has previously confirmed the effect of psychosocial factors such as stress and how it reacts to the onset and course of the disease. .Most of the patients with malignant tumor had negative emotional problems such as anxiety and depression .Depression in cancer is markedly different from depression in healthy individuals, and involves a unique symptomatology and a strong biological etiology. Conclusions: A better understanding of the bidirectional communication between the neuroendocrine and immune systems could contribute to new clinical and treatment strategies.

Assistive Technology Use and Provision During COVID-19: Results From a Rapid Global Survey.

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted all segments of society, but it has posed particular challenges for the inclusion of persons with disabilities, those with chronic illness and older people regarding their participation in daily life. These groups often benefit from assistive technology (AT) and so it is important to understand how use of AT may be affected by or may help to mitigate the impacts of COVID-19. Objective: The objectives of this study were to explore the how AT use and provision have been affected during the initial stages of the COVID-19 pandemic, and how AT policies and systems may be made more resilient based on lessons learned during this global crisis. Methods: This study was a rapid, international online qualitative survey in the 6 United Nations (UN) languages (English, French, Spanish, Russian, Arabic, Mandarin Chinese) facilitated by extant World Health Organization (WHO) and International Disability Alliance networks. Themes and subthemes of the qualitative responses were identified using Braun and Clarke’s 6-phase analysis. Results: Four primary themes were identified in in the data: Disruption of Services, Insufficient Emergency Preparedness, Limitations in Existing Technology, and Inadequate Policies and Systems. Subthemes were identified within each theme, including subthemes related to developing resilience in AT systems, based on learning from the pandemic. Conclusion: COVID-19 has disrupted the delivery of AT services, primarily due to infection control measures resulting in lack of provider availability and diminished one-to-one services. This study identified a need for stronger user-centred development of funding policies and infrastructures that are more sustainable and resilient, best practices for remote service delivery, robust and accessible tools and systems, and increased capacity of clients, caregivers, and clinicians to respond to pandemic and other crisis situations.

COMMON HEALTH PROBLEMS AND UTILIZATION OF PRIMARY HEALTH CARE SERVICES IN THE RURAL AREAS OF THUA THIEN HUE PROVINCE

Although health status in Vietnam has been much improved, people living in rural areas have faced several challenges, including a rapid increase of the aging population, inadequate capacity of health system, and problems of inequities in access to the healthcare system. Objectives: This study aimed to explore the common health problems and health care utilization of people living in the rural areas of Thua Thien Hue province. Methods: A cross-sectional study and geography information system application were carried out. A total of 2.631 individuals in 599 households of a lowland area and a mountainous area was interviewed with a structured questionnaire regarding to health status and health care utilization during the last 6 months. Geography information system software was used to visualize these data of household. Results: 32.8% of participants reported at least an episode of illness within 6 months prior to the interviews. Most of illness people lived in mountainous area. Fever, uncomplicated hypertension, cough, and headache were reported as the most common health problems among participants. Most of participants preferred to visit commune health centers and district hospitals. People in different areas have a significant difference trend from another in choosing health facilities. Conclusion: Residents in difficult-to-reach areas had high prevalence of health problems and experienced social and structural barriers of healthcare services access. It is necessary to improve the availability and quality of primary care services to improve the health status and accessibility of disadvantaged people. Keywords: primary care, utilization, rural areas, health care acessibility

The influence of personal communities in understanding avoidable emergency department attendance: qualitative study

BackgroundUse of emergency department (ED) care globally seems to be increasing at a faster rate than population growth (Baker, House of Commons Library. Accident and Emergency Statistics, Demand, Performance, 2017). In the UK there has been a reported 16% rise in emergency admissions over the past 5 years. Estimates that between 11 and 40% of ED attendances are non-urgent, with 11% of patients being discharged from the ED without treatment (NHS Digital 2017), and a further 44% require no follow-up treatment (NHS Digital, Hospital Accident and Emergency Activity 2016-17, 2019) is cited as evidence that these patients did not require this level of care. The solution to not using the most appropriate point in the system has traditionally been seen as a knowledge problem, requiring, improved sign-posting and information to enable people to self-manage or use health care management for minor ailments. However research about help-seeking behaviour suggests that the problem may not be an informational one. A considerable literature points to help seeking as a social process influenced by a range of contingencies and contextual factors including the way in which lay people influence health care utilisation (Giebel et al. BMJ Open 9:1, 2019). Personal communities comprise a variety of active and significant social ties which have potential to influence individual capacity to seek help. Here we extend and unpack further influencing decisions about seeking formal health care with reference to how they are shaped and informed by and within personal social networks.MethodsWe undertook a personal network mapping and qualitative interview-based study to look at, problematize and understand attendance for non-urgent problems. We used network analysis and methods to map and characterise the personal communities of people seeking help from ED for minor ailments and semi-structured interviews with 40 people attending a single ED and associated GP hub providing equivalent care. Interviews were built around an ego network mapping activity and a topic guide structured to explore attender’s narratives about why they had visited the ED. This ego network activity uses a diagram consisting of three concentric circles (Fiori et al. J Gerontol B-Psychol 62: 322-30, 2007), representing closest social network members (in the centre) and those at further distance. Participants were initially presented with one of these diagrams and asked to write names of people or resources that had played a role in their attendance and the interviewer probed the interviewee to discuss the actions, input and value of the people and services that supported the visit to the ED.ResultsWe analysed number and type of network connections and undertook a thematic analysis to identify how imagined and actual network members and influences were implicated in ED attendance. The network maps created during the interviews were examined and a typology of networks was developed and used to distinguish different types of networks informed by our reading of the data, and a Network Typology Scoring Tool, a measure of frequency of contact and relationship type in networks.ConclusionsOur study suggests that faced with acute minor illness or injury people’s networks narrow: they do not (and perhaps cannot) mobilise their imagined care network because the resources or connections may not be there or are difficult to engage. In addition we identified important system drivers of behaviour, notably that these patients are often directed to the ED by ‘professional influencers’ including health services staff.