Regular Health Care Research Articles

Hurdles in the Access of Regular Dental Care among the Medical & Dental Students of Lahore

Introduction: Despite the great leaps in oral health globally, many countries of the world still face a horde of dental problems. Especially poverty ridden populations of the developing nations. Distribution of oral disease varies among different communities and sometimes even in the same community due to various environmental factors, factors of personal hygiene and oral habits among different demographics. However, the condition of oral health in the patients of Lahore is abysmal as determined by various previous dental surveys. The prevalence of cavities in dental patients is 82.3% while the rest of 17.7% have swollen gums, abscess, infection, and pain. Thus, this study aims to test the barriers in the way of regular dental care by evaluating a major portion of medical and dental students by using a cross sectional, questionnaire-based study, and to make regular dental care more accessible to the students of this metropolis.
 Objective: To determine the factors that become a hurdle in the way of regular dental care among the medical and dental students of Lahore and to pave the way for further studies on this topic.
 Methodology: This survey, after approval from the Internal Review Board of de’Montmorency College of Dentistry, was carried out from July to October 2021. Sample size was calculated using OpenEpi, keeping the confidence level at 95% and the margin of error at 6%. The sampling population included 234 respondents who were randomly selected from 4 different medical and dental colleges of Lahore including both public and private sector colleges. Data was collected using a structured questionnaire titled; Questionnaire for Assessment of Perceived Oral Health Care Needs, Barriers to Accessing Oral Health Care Services and Its Utility8. Statistical analysis was performed using SPSS® version 22.
 Result: All of the participants were students of medical and dental colleges of Lahore. More than half of the participants agreed to have not visited a dentist regularly for regular checkups for maintenance of oral health. About 55% of the participants agreed to not visiting a dentist due to fear of infection transmission. We also found a significant association between the stream of education and regular dental visits (p=0.000).
 Conclusion: For medical and dental students, the biggest barrier in regular oral healthcare is fear of infection transmission, and unavailability of time. However, fear of dental procedures and high cost of service also play a role. Moreover, the high cost of service is not as strong of a factor as it is for the general population.

Cross-national comparisons of health indicators require standardized definitions and common data sources

BackgroundHealth indicators are used to monitor the health status and determinants of health of the population and population sub-groups, identify existing or emerging health problems which would require prevention and health promotion activities, help to target health care resources in the most adequate way as well as for evaluation of the success of public health actions both at the national and international level. The quality and validity of the health indicator depends both on available data and used indicator definition. In this study we will evaluate existing knowledge about comparability of different data sources for definition of health indicators, compare how selected health indicators presented in different international databases possibly differ, and finally, present the results from a case study from Finland on comparability of health indicators derived from different data sources at national level.MethodsFor comparisons, four health indicators were selected that were commonly available in international databases and available for the Finnish case study. These were prevalence of obesity, hypertension, diabetes, and asthma in the adult populations. Our evaluation has three parts: 1) a scoping review of the latest literature, 2) comparison of the prevalences presented in different international databases, and 3) a case study using data from Finland.ResultsLiterature shows that comparability of estimated outcomes for health indicators using different data sources such as self-reported questionnaire data from surveys, measured data from surveys or data from administrative health registers, varies between indicators. Also, the case study from Finland showed that diseases which require regular health care visits such as diabetes, comparability is high while for health outcomes which can remain asymptomatic for a long time such as hypertension, comparability is lower. In different international health related databases, country specific results differ due to variations in the used data sources but also due to differences in indicator definitions.ConclusionsReliable comparison of the health indicators over time and between regions within a country or across the countries requires common indicator definitions, similar data sources and standardized data collection methods.

Annual biological variation and personalized reference intervals of clinical chemistry and hematology analytes.

A large number of people undergo annual health checkup but accurate laboratory criterion for evaluating their health status is limited. The present study determined annual biological variation (BV) and derived parameters of common laboratory analytes in order to accurately evaluate the test results of the annual healthcare population. A total of 43 healthy individuals who had regular healthcare once a year for six consecutive years, were enrolled using physical, electrocardiogram, ultrasonography and laboratory. The annual BV data and derived parameters, such as reference change value (RCV) and index of individuality (II) were calculated and compared with weekly data. We used annual BV and homeostatic set point to calculate personalized reference intervals (RIper) which were compared with population-based reference intervals (RIpop). We have established the annual within-subject BV (CVI), RCV, II, RIper of 24 commonly used clinical chemistry and hematology analytes for healthy individuals. Among the 18 comparable measurands, CVI estimates of annual data for 11 measurands were significantly higher than the weekly data. Approximately 50% measurands of II were <0.6, the utility of their RIpop were limited. The distribution range of RIper for most measurands only copied small part of RIpop with reference range index for 8 measurands <0.5. Compared with weekly BV, for annual healthcare individuals, annual BV and related parameters can provide more accurate evaluation of laboratory results. RIper based on long-term BV data is very valuable for "personalized" diagnosis on annual health assessments.

Health Service Utilization by Homeless Persons: Analysis of the Role of Enabling Factors, Pain and Gender using the Gelberg-Andersen Model

The aim of the study was to find factors that influence health service utilization by homeless people. In a field study, a sample of 51 homeless men and 47 homeless women in the German county of Baden-Württemberg participated in face-to-face-interviews with a questionnaire designed for this study. Analyses were performed using multiple logistic regression models. Variables were organized using the Gelberg-Andersen Behavioral Model for Vulnerable Populations. Satisfied subsistence needs (OR 1.33, 95%-CI [1.03-1.72] regarding utilization of vaccinations), a stable source of primary care (OR 12.2 [1.81-82] regarding utilization of early detection examinations; quasi-complete separation regarding use of GP services) social networks (OR 2.9 [1.13-7.5] regarding utilisation of early detection examinations; OR 0.63 [0.41-0.98] regarding emergency department visits) and technological ressources (OR 2.2 [1.13-4.4] regarding use of GP services) had a positive influence on the pattern of health service utilization. Pain was correlated with more emergency department visits (OR 1.72 [1.22-2.4]) and hospitalizations (OR 1.66 [1.19-2.3]). The results showed differences between homeless men and women. The factors of influence found in this study should be addressed in the care of homeless persons. Integration of social care into the regular health care system is necessary for early detection and treatment of complex social and medical needs of vulnerable populations. This requires interprofessional approaches in medical education and training focussing on the situation of vulnerable populations and on social determinants of health.

Opinion Survey of Paediatricians on Vaccination Status of Refugee Children - Challenges of a Medical Connection to the Regular Outpatient Care System

In addition to the primary health care of refugees, their integration into the regular outpatient care system should be ensured. Initial data suggest that a gap of vaccination among (school) children of refugee families might have emerged in the period between the first general inspection on arrival (the first central health measure) and the transition to the local health care system. The aim of this study was to obtain the opinion of practicing paediatricians regarding the vaccination status of refugee children to examine whether a variance in the measles, mumps, rubella (varicella) vaccination schedule might have emerged between the periods of initial admission and school enrolment examination. Evaluations of both inhibiting and promoting conditions should generate fields of action regarding the systematic integration into the regular health care system. Qualitative interviews with experts as well as a quantitative questionnaire survey to measure the opinion of registered paediatricians in Münster were analyzed. The assessments showed that there was no clear vaccination gap among (school) children of refugee families. One challenge was the systematic integration into the local outpatient care system. Critical issues were inadequate vaccination education, language barriers, and frequent changes in location. The vaccination engagement and vaccination behaviour of refugees were assessed as most positive. International standards, in particular the sphere standards, attracted insufficient attention in practical implementation within the refugee relief programs. Based on the results, it is possible to identify fields of action for the prevention of vaccination gaps among refugees as well as for their systematic integration into the regular outpatient care system. The sphere standards as international standards should be incorporated more consciously.

TP8.1.9 Effect of Covid 19 on breast referrals from GP

AimCoronavirus disease 2019 (COVID-19) has put a strain on regular healthcare worldwide. This study shares a DGH experience of effect of covid 19 on breast referrals from GP.MethodsIt is a single centre retrospective comparative study to analyze the effect of Covid 19 on breast referrals during the pandemic.Patients referred under TWR from 15th march to 15th July 2020 were included and a comparison was made with March to July 2019. The primary outcome was number of referrals and number of cancer diagnosis.Secondary outcomes were breach in 62 day pathway.ResultsIn Covid pandemic, 1231 symptomatic patient were referred under TWR, of which 91 (7.4%) were diagnosed with breast cancer. There were 22 (24%) 62 days breaches.Comparing this with similar 4 months in 2019 there were 1826 symptomatic patients referred under TWR of which 131 (7.1%) diagnosed with cancer. There were 34 screen detected cancers as well. There were 28 (21%)62 day breaches.The reduction in GP referral was 32%.ConclusionThere was an overall decrease in number of patients referred from GP but cancer diagnosis remained almost same for symptomatic patients since TWR pathway carried on with telephonic clinics & assessments at nearby closed screening centres.

Using foresight methodologies to tackle SARS-COV-2 related health impacts

Abstract Background A better understanding of possible future developments is essential for policy makers to anticipate and influence these trends. Public health foresight studies (PHFS) are tools to support this. The current health crisis makes clear that PHFS are necessary more than ever to target possible future impacts resulting from SARS-COV-2 induced changes in e.g. regular health care services, lifestyle and socio-economic developments. To support European countries in doing their own foresight studies, PHIRI aims to strengthen foresight capacity. Methods PHIRI follows a 4-step approach: 1. Making an inventory of current PHFS capacities and capacity needs across European countries using desk research and an online survey; 2. Providing PHFS capacity building via a training course and workshops; 3. Supporting the development of public health scenarios for the short term (0-5 years) and longer-term (5-20 years); 4. Supporting the identification of promising policy strategies, using policy dialogues. Results The online survey was completed by participants of 21 countries and shed light on existing national PHFS and needs for capacity building. It also provided a basis for the development of a professional network on PHFS within the project. Literature research revealed a range of studies using stakeholder involvement and scenario analysis to explore alternative futures. A PHFS capacity building course was developed consisting of three parts: a general, introductory module; three advanced modules deepening on several PHFS elements; and a final module evaluating and preparing countries for developing scenarios together. Conclusions There is a lot of interest in using foresight in public health, especially in these times of crisis. PHIRI provides more insight in the wider public health impacts of the SARS-COV-2 pandemic and in translating this into policy options.

Older persons' experience of eHealth services in home health care: A meta-ethnography eHealth services in home health care.

This study aimed to describe older persons' experiences of eHealth services in home health care. A meta-ethnographic approach was applied, and a systematic literature search was conducted in three databases. In total, 11 articles were included and analysed, which resulted in two themes and six sub-themes. The results show that for older persons to use the eHealth services, they must provide some additional value compared to current contacts with healthcare professionals. Those with regular healthcare contact do not experience the eHealth service as adding anything to the care they already receive. The introduction of eHealth services involves learning how to use the new technology, and some older persons experience the technology as motivating and inspiring. The eHealth service makes some feel safer while some do not trust the technology. In order to make the best use of eHealth services, it is important that the services are adjusted not only to each person's needs but also to their personal capabilities and resources, while the older person must feel valued as an active partner in the care process. Thus, when using eHealth services, the older person's perspective needs to be given priority and decisions should not only be based on organizational considerations.

A Study on Singapore’s Ageing Population in the Context of Eldercare Initiatives Using Machine Learning Algorithms

Ageing has always directly impacted the healthcare systems and, more specifically, the eldercare costs, as initiatives related to eldercare need to be addressed beyond the regular healthcare costs. This study aims to examine the general issues of eldercare in the Singapore context, as the population of the country is ageing rapidly. The main objective of the study is to examine the eldercare initiatives of the government and their likely impact on the ageing population. The methodology adopted in this study is Cross-Industry Standard Process for Data Mining (CRISP-DM). Reviews related to the impact of an ageing population on healthcare systems in the context of eldercare initiatives were studied. Analysis methods include correlation and machine learning algorithms, such as Decision Tree, Logistic Regression and Receiver Operating Characteristics curve analysis. Suggestions have been provided for various healthcare and eldercare systems’ initiatives and needs that are required to transform to cope with the ageing population.

Explaining the willingness of clinicians to work with patients with antisocial personality disorder using the theory of planned behaviour and emotional reactions.

Many clinicians seem to experience negative emotions towards patients with antisocial personality disorder (ASPD), resulting in the exclusion of patients in many treatment programmes. The behaviour of individuals with ASPD has a significant impact on society, which affects ASPD patients and their environment, and therefore, the exclusion from programmes is a serious concern. Relatively, little is known about why some clinicians are willing to work with ASPD patients and others are not and what factors contribute to an increase in the motivation to do so. In this study, clinicians (n = 130) working in a regular and forensic mental health service in the Netherlands completed a questionnaire based on the theory of planned behaviour (TPB) and the Feeling Word Checklist and questions about the relevant experience gained and education received. The current study confirms the limited willingness to work with ASPD patients, especially in regular mental health care. Experience working with ASPD patients, education on cluster B personality disorders and having experienced verbal and/or physical violence in clinical practice did not fully explain whether or not clinicians were motivated to provide treatment to ASPD patients. TPB appeared to predict the intention to provide psychological therapy to ASPD patients adequately. The impact of positive emotions towards ASPD patients on providing treatment appeared to be stronger than negative emotions. This study provides more insight into why so few clinicians are willing to work with ASPD patients and what may increase motivation to include this group in treatment programmes.

The effect of user interface on treatment engagement in a self-guided digital problem-solving intervention: A randomized controlled trial

BackgroundResources are spent worldwide on the development of digital platforms and their user interfaces (UIs) for digital mental health services (DMHS). However, studies investigating the potential benefits of different UIs for DMHS are currently lacking. To fill this knowledge gap, the aim of this study was to investigate differences in treatment engagement between two different UIs for DMHS. MethodsA total of 397 participants from the Swedish general public were randomized (1:1) to use a self-guided digital problem-solving intervention during one week, either with an optimized UI (N = 198), based on user experience (UX) design principles and with automated features, or a basic UI (N = 199), analogous with a UI used in Swedish regular health care comprising elementary UI features and less automation. Primary outcome measures were self-rated usability, on the System Usability Scale, and treatment credibility, on the Credibility/Expectancy Questionnaire. Secondary outcome measures included behavioral engagement with the intervention. FindingsThere were no significant differences between the UIs in ratings of usability or treatment credibility. However, participants who used the optimized UI were significantly more engaged with the intervention as measured by usage of the intervention at least once (odds ratio 2.54, 95% CI [1.67, 3.85]), total number of generated solutions (mean difference 1.41, 95% CI [0.72, 2.11]), and mean number of generated solutions per initiated problem-solving attempt (mean difference 1.45, 95% CI [1.06, 1.85]). Other findings included participants using the optimized UI rating the intervention as easier to understand, while feeling more overwhelmed, than those using the basic UI. InterpretationOur findings indicate that an optimized UI based on UX design principles, in comparison to a basic UI comprising elementary UI features, do not affect overall self-rated usability or treatment credibility but increases some measures of behavioral engagement with a digital intervention. FundingFunded by the Government of Sweden, Ministry of Health and Social Affairs.

The impact of caring for an individual with aromatic l-amino acid decarboxylase (AADC) deficiency: a qualitative study and the development of a conceptual model

Background Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare neurological condition, associated with a wide range of symptoms and functional issues, such as profound motor impairment and learning disability. Most individuals with AADC deficiency are completely dependent on their caregivers. This study explored the impact of caring for an individual with AADC deficiency. Methods Qualitative interviews were conducted with caregivers of individuals with AADC deficiency in Italy, Portugal, Spain and the United States. An interview guide was developed with input from clinical experts and caregivers and included questions on the impact of caring for an individual with AADC deficiency. Interviews were conducted by telephone/videoconference and were recorded and transcribed. Data were analysed using thematic analysis. Results Fourteen caregivers took part who provided care to 13 individuals with AADC deficiency aged 1–15 years. Caregivers reported that their lives centred around the individual with AADC deficiency, due to their need for 24-hour care and regular healthcare appointments. They reported both proximal impacts (impact on time, planning, physical health and emotional wellbeing), and distal impacts (impact on social/leisure activities, relationships, work and finances). These concepts and relationships were illustrated in a conceptual model. Conclusions This is the first qualitative study to report on the experience of caring for an individual with AADC deficiency. Caregivers reported that caring had a substantial multifaceted impact on their lives. These findings highlight the importance of considering the caregiver experience when evaluating the burden of AADC deficiency.

Older adults with non-communicable chronic conditions and their health care access amid COVID-19 pandemic in Bangladesh: Findings from a cross-sectional study.

Burgeoning burden of non-communicable disease among older adults is one of the emerging public health problems. In the COVID-19 pandemic, health services in low- and middle-income countries, including Bangladesh, have been disrupted. This may have posed challenges for older adults with non-communicable chronic conditions in accessing essential health care services in the current pandemic. The present study aimed at exploring the challenges experienced by older Bangladeshi adults with non-communicable chronic conditions in receiving regular health care services during the COVID-19 pandemic. The study followed a cross-sectional design and was conducted among 1032 Bangladeshi older adults aged 60 years and above during October 2020 through telephone interviews. Self-reported information on nine non-communicable chronic conditions (osteoarthritis, hypertension, heart disease, stroke, hypercholesterolemia, diabetes, chronic respiratory diseases, chronic kidney disease, cancer) was collected. Participants were asked if they faced any difficulties in accessing medicine and receiving routine medical care for their medical conditions during the COVID-19 pandemic. The association between non-communicable chronic conditions and accessing medication and health care was analysed using binary logic regression model. Most of the participants aged 60-69 years (77.8%), male (65.5%), married (81.4%), had no formal schooling (58.3%) and resided in rural areas (73.9%). Although more than half of the participants (58.9%) reported having a single condition, nearly one-quarter (22.9%) had multimorbidity. About a quarter of the participants reported difficulties accessing medicine (23%) and receiving routine medical care (27%) during the pandemic, and this was significantly higher among those suffering from multimorbidity. In the adjusted analyses, participants with at least one condition (AOR: 1.95, 95% CI: 1.33-2.85) and with multimorbidity (AOR: 4.75, 95% CI: 3.17-7.10) had a higher likelihood of experiencing difficulties accessing medicine. Similarly, participants with at least one condition (AOR: 3.08, 95% CI: 2.11-4.89) and with multimorbidity (AOR: 6.34, 95% CI: 4.03-9.05) were significantly more likely to face difficulties receiving routine medical care during the COVID-19 pandemic. Our study found that a sizeable proportion of the older adults had difficulties in accessing medicine and receiving routine medical care during the pandemic. The study findings highlight the need to develop an appropriate health care delivery pathway and strategies to maintain essential health services during any emergencies and beyond. We also argue the need to prioritise the health of older adults with non-communicable chronic conditions in the centre of any emergency response plan and policies of Bangladesh.

Oral hygiene and health-related quality of life in institutionalized older people

Key summary pointsAimWe evaluated oral hygiene level and its association with oral health and general health-related quality of life (HRQoL) among older residents in long-term care facilities.FindingsOnly one-fifth of residents had good oral hygiene. Poor oral hygiene was associated with poor oral health and diminished HRQoL.MessageOral hygiene, oral health, and HRQoL may be improved with oral care education of caregivers, professional cooperation, and regular oral healthcare of older residents in long-term care facilities.

Regular Healthcare Provider Status Does Not Moderate Racial/Ethnic Differences in Human Papillomavirus (HPV) and HPV Vaccine Knowledge.

Background: Racial/ethnic minorities generally have a lower knowledge of human papillomavirus (HPV) and the HPV vaccine than non-Hispanic Whites. They are also less likely to have a regular healthcare provider (HCP). Given the role of HCPs in disseminating health information, we evaluated whether racial/ethnic disparities in HPV knowledge are moderated by regular HCP status. Methods: Data from the Health Information National Trends Survey Five (HINTS 5) Cycles One and Two (2017–2018) were analyzed. HPV and HPV vaccine knowledge were compared by regular HCP status across race/ethnicities. Independent partially-adjusted multivariable logistic regression models were used to assess the association between race/ethnicity and knowledge after controlling for sociodemographic characteristics. The resulting adjusted odds ratios were compared to those from fully-adjusted models that included HCP status. Results: After adjusting for regular HCP status, differences in knowledge persisted between racial/ethnic groups. Compared to Whites, Hispanics and Other race/ethnicities had significantly lower odds of having heard of HPV. Blacks, Hispanics, and Other race/ethnicities had significantly lower odds of having heard of the HPV vaccine. Conclusion: Racial/ethnic minorities had significantly lower levels of knowledge despite HCP status. These data suggest the need to address disparities in health information and strengthen provider–patient communication regarding HPV and the HPV vaccine.

Factors Affecting Portal Usage Among Chronically Ill Patients During the COVID-19 Pandemic in the Netherlands: Cross-sectional Study.

BackgroundThe COVID-19 pandemic has impacted the capacity of the regular health care system, which is reflected in limited access to nonurgent care for patients who are chronically ill in the Dutch health care system. Nevertheless, many of them still depend on health care assistance to manage their illnesses. Patient portals are used to provide continued health care (remotely) and offer self-management tools during COVID-19 and potentially after. However, little is known about the factors influencing portal use and users’ satisfaction among patients who are chronically ill during the COVID-19 pandemic.ObjectiveThis study aims to examine predictors of patient portal use among patients who are chronically ill, the willingness to recommend the portal to others, and the likelihood of future use among portal nonusers.MethodsAn online self-administered questionnaire was distributed among patients who are chronically ill via social media in May 2020. The questionnaire consisted of four parts: (1) demographics including age and hours of daily internet use; (2) physical health status including COVID-19 infection, perceived level of control, and hospital visits; (3) mental health status including depression and life satisfaction; and (4) portal use including response waiting time and awareness. Descriptive, correlation, univariate, and multivariate analyses were conducted to identify factors that affect portal use, users’ willingness to recommend, and nonusers’ likelihood of future portal use.ResultsA total of 652 patients responded, and 461 valid questionnaires were included. Among the 461 patients, 67% (n=307) were identified as patient portal users. Of the nonusers, 55% (85/154) reported not being aware of the existence of a patient portal at their hospital. Significant predictors of portal use include level of control (P=.04), hospital visit time (P=.03), depression scale (P=.03), and status of life satisfaction (P=.02). Among portal users, waiting time to get a response via the portal (P<.001) and maximum acceptable waiting time (P<.001) were the strongest predictors for willingness to recommend the portal; among nonusers, the model predicted that those who were not aware of patient portals (P<.001) and were willing to wait moderately long (P<.001) were most likely to use the portal in the future.ConclusionsThis study provides insights into factors that influence portal use and willingness to recommend, based on which health care providers can improve the adoption of patient portals and their services. It suggests that health care providers should leverage efficient operations management to improve responsiveness and reduce waiting time to enhance user satisfaction and willingness to recommend use. Health care organizations need to increase portal awareness among nonusers and train their patients to increase both use and longer adoption of patient portals. Factors including depression and life satisfaction can influence portal use; therefore, future studies on determinants of portal use and nonuse in this specific population are needed.

Relationship between Masticatory Function and Bone Mineral Density in Community-Dwelling Elderly: A Cross-Sectional Study.

The relationship between masticatory function and bone mineral density (BMD) is unclear. This cross-sectional study examined this relationship after adjusting for confounding factors. The subjects were 702 community-dwelling elderly adults (306 men, 396 women) who had been recruited for the Community-Based Healthcare Research and Education study in 2019. Objective masticatory function was assessed using the gummy jelly method. The median for each descriptive statistic was 69.0 years for age, 86.2% for the young adult mean, and 18.0 for masticatory function. Comparisons of the groups with good and poor masticatory function by sex revealed a significant difference in muscle mass and the tooth number for both sexes (p < 0.05). Men showed significant differences in age (p < 0.05) and salivary occult blood findings (p < 0.05). Multivariate analysis using propensity scores showed a significant association between masticatory function and BMD in both sexes (men: odds ratio 163.0, 95% confidence interval 1.36–19,610.55, p = 0.04; women: odds ratio 48.65, 95% confidence interval 1.52–1561.15, p = 0.03 in women). Masticatory function and BMD in the community-dwelling elderly may be related. However, other factors, including frailty and sarcopenia, may also be involved. Regular oral health care by dentists and dental hygienists may benefit this population.

Call to Action

Low quality healthcare services can hinder economic and social development, result in premature death and disability, and waste human capital. To compound pre-pandemic healthcare access and equity issues, the quality of care that is delivered in low, lower-middle, as well as in high-income OECD countries, can be uneven, poorly funded and without adherence to standardization. COVID-19 has highlighted the importance of high quality healthcare, while exacerbating many challenges. How services are delivered and the underlying guidance or standards that support the delivery of high-quality care are not necessarily a part of the regular healthcare reform dialog. This position paper introduces a new standard, ISO CD 7101, that seeks to address problems, and offer solutions for, the quality of healthcare delivered globally. This paper describes the need for such a standard, its history, advantages, and how it answers the global call to action set forth by the OECD, The World Bank, and the World Health Organization.

Quality of life in patients with IBD during the COVID-19 pandemic in the Netherlands

ObjectiveCOVID-19 has put a strain on regular healthcare worldwide. For inflammatory bowel disease (IBD), gastrointestinal surgeries were postponed and changes in treatment and diagnostic procedures were made. As abrupt changes...

The Outbreak of COVID-19 and its Manifold Socio-psychological Implications: A Case Study of District Khyber, Khyber Pakhtunkhwa, Pakistan

After the outbreak of COVID-19 and the subsequent suspension of trade, closure of international borders and restrictions on movement and quarantines, economic and social crisis — coupled with psychological distress — fomented worldwide. The pandemic has caused unprecedented educational, social, economic, psychological and political impacts with varying implications around the globe. The current study was conducted to guage and asses the socio-psychological impacts of COVID-19 in District Khyber, Khyber Pakhtunkhwa, Pakistan. Primary data was collected for the current study from 200 participants through face to face interviews. The data was analyzied under the “Thematic Content Analysis”. The findings of the study shows that the disease and the subsequent social distancing have put at stake the social cohesion and normaldom. In the wake of the disease, domestic abuse, aggression and violence increased making women prey to the predators’ anger, abuse and battering; religious events suffered suspension or disruption; The schools’ closure has had profound negative impacts on children’s conduct; the deteriorating economic situation and the swelling poverty of the masses have lead to a hike in the crimes’ rate; the transgender community has suffered economic plight; women’s regular health care services such as contraceptions, safe abortions and other maternity ailments have suffered notably; schools closure has set off hazardous implications for girls such as harassment, abuse, rape, teen-age pregnancy and sexually transmitted diseases. Resultantly, the people of the area have been suffereing acute trauma, videlicit boredom, fear, anxiety, frustration, and insomnia enticing them towards unhealthy activities viz. use of sedatives, smoking, alcohol usage, and, above all, internet and online unethics. The recommendations should be implemented to help people avoid the downright negative impacts of the COVID-19 and, besides, to help the government to devise a mechanism to combat the pandemic.