Ongoing Medical Care Research Articles

Generating An Insight on Retirement Process of Football Players

The retirement process of professional football players represents a significant life transition that often entails various challenges, including financial instability, career uncertainty, and mental health issues. This article explores the obstacles that retired players may encounter, including the lack of financial literacy and career planning, football-related injuries, and mental health and identity reconstruction issues. By addressing these challenges and implementing proactive financial planning strategies, retired football players can navigate the complexities of retirement more effectively and secure a successful and sustainable future beyond their playing careers. For the provision of psychological support, it is essential for clubs and sports organizations to offer access to mental health resources such as counseling and therapy. Establishing a community for retired athletes can facilitate connections and establish a support network, aiding them in adjusting to their new lives. In terms of physical health, it is crucial to prioritize ongoing medical care and rehabilitation programs. Regular check-ups and availability of physiotherapy can assist in managing chronic conditions and promoting overall well-being. Encouraging retired players to participate in physical activities that they enjoy can also contribute to maintaining fitness and health.

Emergency safe havens

This paper describes how to find or create protective shelter in disaster zones. Federal Urban Search & Rescue (US&R) teams pre-stage directly in the path of on-coming hurricanes and floods, and these forward-positioned teams must seek out buildings and rooms that can survive these events. Safe havens are also needed for those civilians who can’t be evacuated, including the disabled and critically ill. Safe havens are also important in the aftermath of a disaster. Critical work continues for days or weeks at disaster zones, at places where buildings and infrastructure are severely damaged, and where hazards persist. Protected spaces are needed for ongoing humanitarian and medical care for survivors. Rescuers, law enforcement, and medical personnel also need safe interior spaces to eat and rehab. US&R teams and other first responders also seek out safe havens inside the “red zone”, the areas of intense damage and hazards where first responders must operate during rescue, fire-fighting, or HazMat mitigation. The authors describe how safe havens can be rapidly identified or created in disaster zones. This aspect of protective structures is of growing importance as the world population becomes more vulnerable to natural and man-made disasters.

Barriers to Accessing Health Care for Patients Living in Poverty: A Qualitative Study of Diabetic Patients in Morocco

Background: Poverty has been identified as a significant barrier to access to care for diabetes patients. Diabetes requires ongoing and adequate medical care, and delays or lack of care can exacerbate the disease and its complications. Objectives: The aim of this study was to explore the barriers that affect access to healthcare among diabetic patients living in poverty in Morocco. Methods: A qualitative study was conducted with 20 diabetic individuals selected through purposive sampling. An interview guide was developed to facilitate in-depth interviews. The data were evaluated using the qualitative content analysis method. Results: Following data saturation, the final sample consisted of 20 participants: Twelve males and eight females, ranging in age from 23 to 83 years old. Three themes were identified as barriers for the poor: Contextual barriers, healthcare institution barriers, and patient barriers. The main findings highlighted the financial difficulties patients face due to the high cost of treatment for their illnesses. There was also an emphasis on issues related to healthcare institutions, including a lack of equipment and medication, staff shortages, distance, transportation, and the nature of the relationship between healthcare providers and patients. Conclusions: The study examined the obstacles to obtaining healthcare for diabetic patients living in poverty. These findings will help generate realistic recommendations for new strategies to improve equitable access to healthcare for the poor.

Cost-effectiveness of promoting population health management through education, seminars, and participatory learning for individuals diagnosed with chronic diseases

Population health management is a sustainable, strategic, and interprofessional collaboration that focuses on the health needs of individuals diagnosed with and living with chronic diseases. A chronic disease is defined as a longstanding health condition that persists for more than a year and requires ongoing medical care, such as heart disease, cancer, and diabetes. Since many chronic diseases are incurable, the management and financial burden of chronic diseases remain significant concerns for individuals, clinicians, and health-care systems. Preventing and managing chronic diseases through health promotion and education continues to be a fundamental cost-effective strategy. Educational seminars and participatory learning for individuals with chronic diseases play an important role in improving health outcomes and reducing health-care costs. This perspective aims to highlight objective insights into how health education contributes to cost-effectiveness and strategic population health management.

Coronary Artery Disease (CAD) Demystified - Causes, Symptoms & Treatment

Coronary artery disease (CAD) stems from risk factors like high blood pressure, cholesterol, and smoking. Atherosclerosis, plaque buildup in arteries, restricts blood flow to the heart, causing symptoms such as chest pain. Diagnosis involves tests like ECGs and angiograms to evaluate blockages and heart function. Treatment focuses on symptom relief and risk reduction through lifestyle changes, medications, and procedures like stent placement or bypass surgery. CAD management requires ongoing medical care and lifestyle adjustments to improve heart health and prevent complications like heart attacks.

Dementia Ideal Care: Ecosystem Map of Best Practices and Care Pathways Enhanced by Technology and Community.

Globally, much work has been done by nonprofit, private, and academic groups to develop best practices for the care of people living with dementia (PLWD), including Alzheimer's disease. However, these best practices reside in disparate repositories and tend to focus on one phase of the patient journey or one relevant group. To fill this gap, we developed a Dementia Ideal Care Map that everyone in the dementia ecosystem can use as an actionable tool for awareness, policy development, funding, research, training, service delivery, and technology design. The intended audience includes (and not limited to) policymakers, academia, industry, technology developers, health system leaders, clinicians, social service providers, patient advocates, PLWD, their families, and communities at large. A search was conducted for published dementia care best practices and quality measures, which were then summarized in a visual diagram. The draft diagram was analyzed to identify barriers to ideal care. Then, additional processes, services, technologies, and quality measures to overcome those challenges were brainstormed. Feedback was then obtained from experts. The Dementia Ideal Care Map summarizes the ecosystem of over 200 best practices, nearly 100 technology enablers, other infrastructure, and enhanced care pathways in one comprehensive diagram. It includes psychosocial interventions, care partner support, community-based organizations; awareness, risk reduction; initial detection, diagnosis, ongoing medical care; governments, payers, health systems, businesses, data, research, and training. Dementia Ideal Care Map is a practical tool for planning and coordinating dementia care. This visualized ecosystem approach can be applied to other conditions.

Sickle Cell Anemia – A Societal and Clinical Challenge in a Wardha City

Sickle cell anemia is a hereditary blood disorder that poses significant clinical and societal challenges, predominantly affecting individuals globally. Clinically, it is marked by severe pain episodes, organ damage, heightened infection risk, and limited treatment options. These complications necessitate comprehensive, ongoing medical care. Societal challenges include healthcare disparities, stigma, psychosocial impacts, and barriers to education and employment. Addressing these issues in Wardha city requires improving access to specialized care, enhancing public awareness, investing in research for new treatments, and providing robust support systems for patients and caregivers. A multifaceted approach involving healthcare providers, researchers, policymakers, and communities is essential to effectively manage and mitigate the impacts of this debilitating disease..

Characterizing Families of Pediatric Patients with Rare Diseases and Their Diagnostic Odysseys: A Comprehensive Survey Analysis from a Single Tertiary Center in Korea

Purpose: Rare diseases necessitate consistent access to specialized health services. In Korea, despite the growing socioeconomic burden, insufficient comprehensive research is available on patients with rare diseases and their families, particularly concerning factors influencing the length of time to diagnosis. The aim of this study was to thoroughly characterize rare pediatric diseases and explore factors impacting the diagnostic odyssey. Methods: The study enrolled patients under 15 years old seeking medical care at the Seoul National University Children’s Hospital Rare Disease Center between January 2022 and December 2023. Participating patients were required to have been diagnosed with one of the 1,248 rare diseases recognized in Korea. A 33-question survey was developed to assess clinical features of the patients, characteristics of their primary caregivers, and their perceptions of ongoing medical care. Results: The study included 101 patients and their families. Regarding perceived cognitive and motor functions, most families indicated moderate or severe limitations (cognitive, 62.4%; motor, 57.4%). Over half of the families (53.5%) reported discontinuing employment to provide patient care. Neurological symptoms represented the most common initial chief concern, with dermatologic symptoms and laboratory test abnormalities also noted. Three factors were associated with time to diagnosis: the number of hospitals visited, whether the districts of residence and diagnosis aligned, and the age at symptom onset.Conclusion: The comprehensive characterization of patients with rare diseases and their families in Korea, along with the identification of factors impacting the diagnostic odyssey, provides key insights for the development of a tailored support system.

ASSESSMENT OF THE RISK FOR FALLS IN THIRD-AGE PERSONS

Introduction: Falls in the elderly population are one of the main geriatric syndromes and a clear indicator of the fragility of the elderly population. Falls are a leading cause of death and injury in the elderly, resulting in disability and immobility requiring ongoing medical care and high treatment costs. Difficulties in performing daily life activities increase with age due to decline in physical and cognitive functioning. Research objectives: To assess the ability to perform daily life activities, to analyze the risks of falling in elderly people. Methods: 100 people over the age of 65 participated in the research. The research instruments were a questionnaire for the assessment of daily life activities - Barthel Scale / Index (BI) and a questionnaire on screening assessments for the evaluation of falls. Results: The Barthel index shows that the majority of respondents perform daily life activities without problems. Intrinsic factors prove that the median score was 12 with an interquartile range of 7 to 15, which represents the risk of falls in people of the third age. Extrinsic risk factors for falls in people of the third age indicate a median of 4 with an interquartile range of 2 to 5, which represents the risk for falls in older people. The most influential risk factors for falling in our survey are difficulty walking upstairs, incorrect or insufficient use of orthopedic aids, feeling of instability when standing up for the first time, complaining of weakness or reduced sensation in one or the other leg, feeling of low self-confidence, instability when walking and fear from falling. Conclusion: Analyzing the risk factors for a fall, we obtained the result that there is an evident risk for a fall. Based on the estimated risk of falling, the most influential risk factors that affect the performance of daily life activities of elderly people were singled out.

Alexithymia in primary ciliary dyskinesia.

Recent evidence suggests that alexithymic deficits in emotional processing may also affect physical health, and alexithymia may also be associated with organic disorders. The emotional well-being of patients with primary ciliary dyskinesia (PCD) is often negatively affected by uncertainty about the prognosis, lack of ongoing medical care, and lack of symptom control. This study aims to evaluate the frequency of alexithymia and its possible impact on the management of childhood PCD. Subjects were recruited from patients with PCD and healthy volunteers aged 8-18 years. The questionnaire included sociodemographic characteristics and self-report scales. Data were compared between patient and control groups. In the >14 years of age group, the total Toronto Alexithymia Scale (TAS-20) score was significantly higher in the patients (56.60 ± 13.01) compared to the control group (46.47 ± 7.50) (p = .007). There were 6 (30) patients with a TAS-20 score ≥61. There was a significant correlation between TAS-20 and Pediatric Quality of Life (PedsQL) score (child), but no correlation between TAS-20 and Kovacs Children Depression Inventory (CDI) and PedsQL score (parents). The TAS-20 score was significantly higher in patients with bronchiectasis (p = .035), nasal polyps (p = .045), and siblings with PCD (p = .001). Furthermore, the TAS-20 score had a significant negative correlation with pulmonary function tests. Although this study is based on limited data from a single center and cannot be generalized to all PCD patient communities, our results show that PCD patients are more likely to have alexithymia compared to healthy controls and highlight the need to evaluate for alexithymia in patients with PCD. It is important for pediatric pulmonologists to have a thorough knowledge of the alexithymic features associated with PCD and to refer patients to pediatric psychiatry when necessary, especially in patients who are noncompliant with treatment protocols.

Associations between Health-Related Quality of Life, Illness Perception, Stigmatization and Optimism among Hematology Patients: a Path Analysis

IntroductionHematological diseases represent a diverse disease group ranging from benign to life-threatening conditions, with hematological malignancies being a major cause of mortality in the population worldwide. Although most hematological diseases require ongoing medical care making these conditions even more difficult for patients to endure. Since these diseases can pose many challenges by causing symptoms and limitations in various aspects of daily life, health-related quality of life (HRQoL) is a crucial aspect of their healthcare. Different dimensions of health-related quality of life are influenced by several psychological factors, including illness perception, stigmatization, and optimism: a more positive illness perception, along with optimism and reduced stigmatization, can contribute to a better HRQoL among hematology patients.ObjectivesSince hematological diseases often cause serious life changes, the current study aimed to explore the direct and indirect effects of illness perception on health-related quality of life among hematology patients in Hungary, including stigmatization and optimism as possible contributors.MethodsIn this cross-sectional study, 96 hematology patients (mean age = 56.45 years; SD = 15.55 years; 43.8% female) completed a self-administered survey including the following instruments: EORTC Quality of Life Scale, Brief Illness Perception Questionnaire, Stigma Scale for Chronic Illness, Revised Life Orientation Test.ResultsBy creating two pathway models, illness perception had significant indirect effects on physical functioning (β = -.205, p < .05) through role and cognitive functioning while emotional functioning had significant indirect effects on social functioning (β = .369, p < .01) through illness perception and stigmatization, both effects moderated by optimism. After controlling for other factors, both illness perception and emotional functioning directly influenced physical and social functioning, respectively.ConclusionsOur study supports previous research on the direct and indirect effects of illness perception on HRQoL. Based on our data, more optimistic illness perceptions and greater emotional functioning improve hematology patients’ health-related quality of life by facilitating an unbiased understanding of the disease. Optimism serves as a potential moderating mechanism by positively altering indirect effects. Healthcare professionals need to optimize patients’ illness perception to improve physical and social functioning.Disclosure of InterestH. Kiss Grant / Research support from: This work was supported by the New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund, #ÚNKP-22-4-SZTE-301., V. Müller: None Declared, K. Dani: None Declared, B. Pikó: None Declared

Effect of laparoscopic mini gastric bypass versus laparoscopic single anastomosis sleeve ileal bypass on serum iron and calcium levels

Background Although bariatric surgery techniques are very effective in the treatment of obesity, they are usually associated with evident nutritional deficiencies. Such operations require ongoing medical care along with vitamin (Vit) and nutrition supplements. Aim Is to determine and compare the effect of Laparoscopic mini gastric bypass (MGB) versus laparoscopic single anastomosis sleeve ileal bypass (SASI) on serum iron and calcium levels. Methodology The current prospective Randomized controlled study included 62 patients who were randomly allocated into one of two equal groups. Group A (n=31) underwent MGB while group B (n=31) underwent SASI. Follow-up was designed for 6 and 12 months in both groups for the serum iron profile, serum folate, Vit B12, Vit D, parathyroid hormone, and calcium level. Results There was a statistically significant decrease in Excess weight loss (EWL)% in both groups after 1, 6, and 12 months and a significant EWL % in group A more than group B (P=0.045*). There was a statistically significant drop in the Iron profile components’ levels in both groups after 1, 6, and 12 months in comparison with the corresponding baseline levels. There was a statistically significant decrease in the calcium level as well as Vit D3 within both groups at 1, 6, and 12 months follow-up with a significant increase in Parathyroid hormone in both groups at the same interval of follow-up. Conclusion Both MGB and SASI are effective methods for the treatment of morbid obesity. However, adherent follow-up for the Iron profile, Vit B12, Vit D3, parathyroid hormone, and calcium levels are mandatory.

Early treatment with fluvoxamine, bromhexine, cyproheptadine, and niclosamide to prevent clinical deterioration in patients with symptomatic COVID-19: a randomized clinical trial

Repurposed drugs with host-directed antiviral and immunomodulatory properties have shown promise in the treatment of COVID-19, but few trials have studied combinations of these agents. The aim of this trial was to assess the effectiveness of affordable, widely available, repurposed drugs used in combination for treatment of COVID-19, which may be particularly relevant to low-resource countries. We conducted an open-label, randomized, outpatient, controlled trial in Thailand from October 1, 2021, to June 21, 2022, to assess whether early treatment within 48-h of symptoms onset with combinations of fluvoxamine, bromhexine, cyproheptadine, and niclosamide, given to adults with confirmed mild SARS-CoV-2 infection, can prevent 28-day clinical deterioration compared to standard care. Participants were randomly assigned to receive treatment with fluvoxamine alone, fluvoxamine+bromhexine, fluvoxamine+cyproheptadine, niclosamide+bromhexine, or standard care. The primary outcome measured was clinical deterioration within 9, 14, or 28 days using a 6-point ordinal scale. This trial is registered with ClinicalTrials.gov (NCT05087381). Among 1900 recruited, a total of 995 participants completed the trial. No participants had clinical deterioration by day 9, 14, or 28 days among those treated with fluvoxamine plus bromhexine (0%), fluvoxamine plus cyproheptadine (0%), or niclosamide plus bromhexine (0%). Nine participants (5.6%) in the fluvoxamine arm had clinical deterioration by day 28, requiring low-flow oxygen. In contrast, most standard care arm participants had clinical deterioration by 9, 14, and 28 days. By day 9, 32.7% (110) of patients in the standard care arm had been hospitalized without requiring supplemental oxygen but needing ongoing medical care. By day 28, this percentage increased to 37.5% (21). Additionally, 20.8% (70) of patients in the standard care arm required low-flow oxygen by day 9, and 12.5% (16) needed non-invasive or mechanical ventilation by day 28. All treated groups significantly differed from the standard care group by days 9, 14, and 28 (p<0.0001). Also, by day 28, the three 2-drug treatments were significantly better than the fluvoxamine arm (p<0.0001). No deaths occurred in any study group. Compared to standard care, participants treated with the combination agents had significantly decreased viral loads as early as day 3 of treatment (p<0.0001), decreased levels of serum cytokines interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) as early as day 5 of treatment, and interleukin-8 (IL-8) by day 7 of treatment (p<0.0001) and lower incidence of post-acute sequelae of COVID-19 (PASC) symptoms (p<0.0001). 23 serious adverse events occurred in the standard care arm, while only 1 serious adverse event was reported in the fluvoxamine arm, and zero serious adverse events occurred in the other arms. Early treatment with these combinations among outpatients diagnosed with COVID-19 was associated with lower likelihood of clinical deterioration, and with significant and rapid reduction in the viral load and serum cytokines, and with lower burden of PASC symptoms. When started very soon after symptom onset, these repurposed drugs have high potential to prevent clinical deterioration and death in vaccinated and unvaccinated COVID-19 patients. Ped Thai Su Phai (Thai Ducks Fighting Danger) social giver group.

Utilization of Early Intervention Among Children with Sickle Cell Disease

Background: The most prevalent monogenic disorder among children is sickle cell disease (SCD). SCD is the most common cause of pediatric stroke and is primarily inherited by people that identify as Black or of African descent. 1,2 Children with SCD have an elevated risk for delayed development and poor academic outcomes. 2 Our previous findings identified that 50% of children with SCD have a developmental delay, however, &amp;lt;5% were receiving therapy services. 3-5 Home-based programs have ameliorated cognitive and language delays in children with SCD. 6 In the United States, home-based therapy services (e.g., occupational, physical, and speech therapy) are provided through a federally mandated program called Early Intervention for free or reduced cost for children with developmental delay &amp;lt;3 years of age. 7 Unfortunately, this program is underutilized, especially in underserved and minoritized communities, with as few as 2% of eligible children receiving services. 8,9 Hematologists, who are tasked with providing ongoing medical care for young children with SCD, often lack the resources/tools needed to incorporate developmental screening into standard care. Thus, early indicators of developmental delay remain undetected and untreated, costing children and families precious time to intervene early. 6,10,11 This study aimed to assess the use of early intervention and determinants affecting participation in developmental screening and intervention among caregivers of children 0-4 years of age with SCD. Methods: We recruited caregivers with children under 4 years of age with SCD from clinics in St. Louis, Missouri and Memphis, Tennessee. Semi-structured interviews based on the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework were used to describe determinants for referral success and describe the mechanisms (barriers and facilitators) that influence early intervention program utilization. 12 Interviews included open-ended to address topics related to reach, perceived effectiveness, and likelihood of adoption of early intervention if recommended. Additional questions assessed caregiver knowledge of developmental delays in SCD and utilization of screening and intervention. Results: Among 127 caregivers identified as eligible, 47 consented and 20 completed an interview between September 2022 and February 2023. Similar to prior studies, over half of caregivers reported living in a low-income household, over half of children had hemoglobin SS and all participants identified as Black or African American. Interviews lasted between 15-75 minutes (mean = 34). Three themes emerged from the data including 1) Caregivers have not been informed about elevated risk for developmental delay, 2) Caregivers prioritize connecting with their provider and 3) Caregivers had not been adequately informed about early intervention services (Table 1). Conclusions: This study highlights the low utilization of early intervention services for young children with SCD. Caregivers expressed frustration with the lack of awareness regarding the elevated risk for developmental delays and prioritize that information coming from their specialty providers (e.g., sickle cell clinic). Additionally, inadequate information about available services contributes to underutilization. As healthcare providers, we are tasked with increasing awareness about the associated risks of SCD, integrating developmental screening into standard care, and providing caregivers with information that could improve developmental outcomes for children with SCD.

Pembrolizumab related osteonecrosis of the jaw

Medication related osteonecrosis of the jaw (MRONJ) is a serious complication with potential implications on patients’ ongoing medical care. This case report describes a case of MRONJ from pembrolizumab; a novel immune checkpoint inhibitor drug.

Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study

BackgroundThe emerging postpartum rehabilitation (PPR) program in Chinese hospitals characterized by applying ongoing medical care through traditional cultural practices shows a protective effect in early puerperium in China. This study explores the benefit of PPR program practices to postpartum depression (PPD) and the influencing factors for PPD among Chinese women during the first postnatal six weeks.MethodsThe cross-sectional study included 403 participants and was conducted in a Secondary Municipal Hospital in Qingdao, China, from 01 to 2018 to 31 December 2021. Information on this PPR program was collected during the six-weeks postpartum consultation, including the Edinburgh postnatal depression scale (EPDS) scores, the measurement results for diastasis recti abdominis, and the international physical activity questionnaire (long form) (IPAQ-L) scores. Logistic regression models were used to examine the effect of the PPR program on PPD among the local population. The secondary aim of this study was to investigate possible influencing factors for PPD, such as coronavirus disease 2019 (COVID-19), physical exercises, etc.ResultsPPR program has shown a positive effect in preventing PPD (p < 0.001) and diastasis recti prevalence (p < 0.001) during the six-weeks postnatal control in Qingdao, China. Better post-pregnancy weight reduction (p = 0.04) and higher metabolic equivalent of task (MET) value (p < 0.001) were noticed in the non-PPR group. Furthermore, lower PPD risk was associated with factors such as longer relationship duration years (2–5 years) (p = 0.04) and exercising one to three times a week (p = 0.01). A higher PPD risk was related to factors such as urinary incontinence during the postpartum period (p = 0.04) and subjective insomnia (p < 0.001). No significant effect was shown between COVID-19 and the EPDS score in this study (p = 0.50).ConclusionOur results suggested that the PPR program provided protection against PPD and diastasis recti during the first six weeks after delivery. Urinary incontinence and subjective insomnia were the main risk factors for PPD, while longer relationship duration years and exercising one to three times a week gave protective effects to PPD. This study emphasized that a comprehensive ongoing medical care program, such as the PPR program, effectively improves women’s mental and physical health in the early postpartum in China.

Hurricane Michael and Adverse Social and Mental Health Risk Factors.

To assess changes in mental health and social risk factors in pregnant women in counties affected by Hurricane Michael (October 2018). Data from the Universal Perinatal Risk Screen (UPRS) and vital statistics for the state of Florida were obtained. Prenatal risk factors (unplanned pregnancy, mental health services, high stress, use of tobacco or alcohol, young children at home or with special needs, trouble paying bills) were compared in the year before and year after Hurricane Michael in affected counties (n = 18,887). Log-Poisson regression with robust variance was used for binary outcomes, adjusting for maternal age, race, BMI, and education. A smaller proportion of pregnant women were screened in the months after the hurricane. No changes were seen in overall scores. The proportion referred was lower in the 1 month after Michael compared to that in 1 month before Michael (RR 0.78, 95% CI = 0.71, 0.86), but greater in the year after (RR = 1.07, 95% CI: 1.04, 1.10). Most individual risk factors on the screener did not change significantly, except having an illness that required ongoing medical care was less common in the short term (3 months after vs. 3 months before: aRR = 0.76, 95% CI: 0.66, 0.87), and more common in the longer term (1 year after vs. 1 year before, aRR = 1.09, 95% CI: 1.02, 1.18). Birth certificate data suggested smoking during pregnancy was higher among women who experienced Michael during their pregnancies (aRR = 1.15, 95% CI: 1.01, 1.32). Perinatal screening and referral declined in the short-term aftermath of Hurricane Michael.

Barriers to COVID-19 vaccine uptake among resource-limited adults diagnosed with chronic illness.

Despite the use of interventions (e.g., monetary incentives, educational campaigns, on-site workplace vaccination) to increase COVID-19 vaccination, differences in uptake persist by poverty level, insurance status, geography, race, and ethnicity, suggesting that these interventions may not be adequately addressing the barriers faced by these populations. Among a sample of resource-limited individuals with chronic illnesses, we (1) described the prevalence of different types of barriers to the COVID-19 vaccination and (2) identified associations between patients' sociodemographic characteristics and barriers to vaccination. We surveyed a national sample of patients with chronic illness and demonstrated healthcare affordability and/or access challenges about barriers to COVID-19 vaccination in July 2021. We categorized participant responses into cost, transportation, informational, and attitudinal barrier domains and assessed the prevalence of each domain, both overall and by self-reported vaccination status. Using logistic regression models, we examined unadjusted and adjusted associations between respondent characteristics (sociodemographic, geographic, and healthcare access) and self-reported barriers to vaccination. Of 1,342 respondents in the analytic sample, 20% (264/1,342) reported informational barriers and 9% (126/1,342) reported attitudinal barriers to COVID-19 vaccination. Transportation and cost barriers were reported much less commonly, by only 1.1% (15/1,342) and 0.7% (10/1,342) of the sample, respectively. Controlling for all other characteristics, respondents with either a specialist as their usual source of care or no usual source of care had an 8.4 (95% CI: 1.7-15.1) and 18.1 (95% CI: 4.3-32.0) percentage point higher predicted probability, respectively, of reporting informational barriers to care. Compared to females, males had an 8.4% point (95% CI: 5.5-11.4) lower predicted probability of reporting attitudinal barriers. Only attitudinal barriers were associated with COVID-19 vaccine uptake. Among a sample of adults with chronic illnesses who had received financial assistance and case management services from a national non-profit, informational and attitudinal barriers were more commonly reported than logistical or structural access barriers (i.e., transportation and cost barriers). Interventions should target attitudinal barriers among patients with chronic illness, who may have particular concerns about the interaction of the vaccine with ongoing medical care. Additionally, interventions targeting informational barriers are particularly needed among individuals without a usual source of care.

Factors influencing sustainable employment of persons with acquired brain injury (ABI) or spinal cord injury (SCI): A qualitative study evaluating the perspective of health and work professionals.

The number of persons with acquired brain injury (ABI) or spinal cord injury (SCI) who leave the labor market early despite successfully return to work post-injury, demonstrates the challenge for them to remain employed. Evidence on how enabling and hindering factors influence daily work across the lifespan and how they affect employment-related services is scarce. Professionals directly involved in work integration can add to this evidence through their experiential knowledge. To identify and explore the factors that enable or hinder sustainable employment for persons with ABI or SCI from the perspective of health and work professionals. We conducted 23 semi-structured interviews with professionals in Switzerland, directly involved in work reintegration and retention of persons with ABI or SCI. Interviews were transcribed verbatim and thematically analyzed. Participants identified three main themes related to the concept of "sustainable employment". First, the value and impact of initial work integration; an early, multidisciplinary, person-centered work integration, with the early involvement of employers is ideal. A good match between the worker and the workplace is sought. Second, critical factors for long-term sustainable work: the main risks for persons with ABI are changing supervisors, workplace restructuring and the introduction of new technologies, while deteriorating health and the occurrence of secondary health problems are the greatest risk for persons with SCI. Third, the relevance of knowledge, experience and attitudes of professionals; Knowledge of the consequences of an ABI or SCI, the legal basis and the social security process, and the attitude of professionals towards the injured worker were considered important. From the professional's perspective, enabling and hindering factors for sustainable employment in the long-term are fundamentally very similar for persons with ABI and SCI. But different physical, mental and neuropsychological effects call for individually adapted measures. While persons with SCI primarily require ongoing medical care, conscious management of changes in the workplace is critical for persons with ABI. For both groups, an easily accessible counseling and support service should be established for work-threatening problems in the long-term. Furthermore, diagnosis-specific training programs for professionals of employment-related services and disability management should be developed.

Effect of Continuity of Care on Chronic Diseases

Chronic diseases are quite prevalent and are associated with grave repercussions and considerable target organ dysfunction. Providing such patients with high-quality care can significantly lower their morbidity and mortality risk. Early disease detection, frequently when the patients are generally asymptomatic, is necessary for the provision of proper care that could reduce the chances of hazardous consequences and complications. The arrangement of care delivery with continuity of care has been shown to provide many health benefits. Numerous beneficial health outcomes have been linked to the continuity of care way of structuring the delivery of care. Continuity of care is defined as the process by which the patient and his or her physician care team work together to manage their ongoing medical care in order to achieve the shared purpose of high-quality, affordable healthcare. Additionally, continuity of care is associated with increased follow-up appointment compliance, more frequent cancer screenings, prevention programs usage, fewer emergency room visits, less hospital admissions, among various others. The continuity of care is influenced by a variety of factors, including equity and effectiveness as well as the quality of care throughout time. Research studies have shown that greater treatment continuity is associated with better mental health, a greater sense of satisfaction, and a higher quality of life. Although, the overuse of medical resources, especially through the provision of unnecessary services, is associated with poor continuity of care. The purpose of this research is to review the available information about the effect of continuity of care on chronic diseases.