Regular Service Research Articles

Universal child health and early education service use from birth through Kindergarten and developmental vulnerability in the Preparatory Year (age 5 years) in Tasmania, Australia

AbstractThis study investigated patterns of universal health and education service use from birth through Kindergarten (age 4 years) and estimated associations between cumulative risk and service use patterns, and between service use patterns and children's developmental vulnerability in the Preparatory Year (age 5 years). The study used population‐wide linkage of health and education administrative data records for 5168 children who had a 2018 AEDC instrument collected in Tasmania and were born in Tasmania (2011–2013). Latent class analysis (LCA) identified three service use patterns: Regular (72.2 per cent of children; reference group), Low (15.6 per cent of children) and High service use (12.2 per cent of children). The patterns of Regular, Low and High service use were consistent across health and education services used at different ages and stages of child development. Membership of the Low and High service use groups was associated with higher cumulative risk and increased odds of developmental vulnerability, relative to the Regular service use group. This population‐wide view of universal service use can be used by the health and education sectors to explore ways in which their specialist expertise, resources and referral processes can be further integrated within and across services to meet the developmental needs of children and families.

Primary care professionals\u2019 experiences during the first wave of the COVID-19 pandemic in Greece: a qualitative study

BackgroundThe coronavirus outbreak (COVID-19) tested health care systems worldwide. This qualitative study aimed to explore and understand the experiences, beliefs and concerns of Primary Care Professionals (PCPs) regarding the preparedness and response of primary care to the first wave of the pandemic in Greece, a country where a public structured primary care system has been developing.MethodsWe conducted semi-structured telephone interviews with 33 PCPs (General Practitioners, community General Internal Medicine Specialists, community Paediatricians and nurses) recruited from all regions of Greece after the first wave of the pandemic (June 2020). Interviews were transcribed verbatim, data were anonymised and analysed. Thematic analysis was applied developing a conceptual framework.ResultsFour main themes were identified: a) Primary care unit adaptation and issues faced during the pandemic; b) Management of suspected COVID-19 cases; c) Management of non-suspected cases; d) Consequences of the pandemic. In the first phase of the pandemic, remote management of suspected cases and their referral to the hospital were preferred as a result of a shortage of personal protective equipment and inaccessibility to coronavirus testing in primary care. Due to the discontinuation of regular medical services and the limited in-person contact between doctors and patients, chronic disease management and prevention programmes were left behind. Social and emotional consequences of the pandemic, such as workplace stigma, isolation and social seclusion, deriving from fear of viral transmission, as well as burnout symptoms and exhaustion were commonly experienced among PCPs. Positive consequences of the pandemic were considered to be the recognition of the importance of an empowered public healthcare system by citizens and the valuable insight, knowledge and experience professionals gained in times of crisis.ConclusionsPrimary care has a key role to play during and after the pandemic by using its information infrastructure to identify at-risk groups, detect new cases of COVID-19, provide care according to needs, and carry out vaccination programmes. Central coordination and empowerment of primary care will increase its effectiveness, via public awareness, holistic patient management, and unburdening of hospitals.

Anticipating the COVID-19-related surge in cancer care demand is urgent in Latin America and the Caribbean.

The COVID-19 pandemic has disrupted regular health services in every health system worldwide, and cancer care is no exception. In Latin America and the Caribbean, cancer services have been reported to be foregone or delayed, including first-time visits to oncology services, pathology, cancer surgery, chemotherapy, and screening tests,1 with similar findings in the paediatric cancer field.2 The study by Zachary J Ward and colleagues3 published in The Lancet Oncology goes a step further; using data from five cancer sites in Chile, their study assesses the future effects of delayed diagnosis on cancer outcomes.

Increasing the uptake of cervical screening at cornerstone medical practice

BackgroundNationally, cervical screening uptake is suboptimal, even though research shows that the programme is highly effective at preventing cervical cancer.Local problemCornerstone is a small practice located in Salford in the...

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.

Refugee Children’s Early Development during Attendance of Specialized Preschool Programs and Transition into First Grade in Germany

ABSTRACT Research Findings: We assessed socio-emotional behavior, nonverbal reasoning, German receptive language, and motor skills of refugee children attending early childhood development [ECD] programs and of those who did not (N = 207, mean age = 69.4 months). Young refugee children overall demonstrated lower levels of development and more socio-emotional behavior problems. Attendance of preschool-based ECD programs was inconsistently linked to better outcomes. Only moderate improvements in German receptive language skills could be supported across different methodological approaches. Although socio-emotional problems of refugee children attending ECD programs persisted on high levels, those children showed overall fewer problems when compared to non-attenders at the transition to first grade, especially less hyperactivity/inattention and more prosocial behavior. Practice or Policy: Our study supports that refugee experiences during early childhood are linked to lower developmental learning foundations. Specialized ECD programs for refugees can compensate a general shortage in regular ECD services in times of increased demands. Such programs thus increase the chances of refugee children to keep pace academically with their non-refugee peers. However, as specialized programs for refugee children establish a non-inclusive route in the early education sector of Germany, they still have to empirically prove quality and promoting effects on the children’s ECD.

Periodontitis- as a risk factor for pulmonary diseases

respiratory disease are responsible for a significant number of deaths and considerable suffering in human. poor health and low immunity state plays a very important role in pathogenesis of respiratory disease.The colonization of the respiratory tract with various oral periodontopathogens may result in respiratory diseases such as bacterial pneumonia.The teeth may also serve as a reservoir for respiratory pathogen colonization and subsequent nosocomial pneumonia. The overreaction of the inflammatory process that leads to the destruction of the connective tissue is present in both periodontal disease and emphysema. The mechanisms of infection could be the aspiration into the lung of oral pathogens capable of causing pneumonia, colonization of dental plaque by respiratory pathogens followed by aspiration, or facilitation of colonization of the upper airway by pulmonary pathogens by periodontal pathogens. Many pulmonary disorders like respiratory obstructive diseases, systemic diseases with pulmonary involvement, lung cancer, cystic fibrosis or tuberculosis all have clinical and/ or therapeutic involvement of the oral cavity, which underlines the necessity of regular dental services and careful oral cavity exam, as well as an active collaboration between dental practitioners and pulmonologists

Healthcare Economics: Financial Impact and Limitations of Telemedicine

In 2020, the US government spent over 4 trillion dollars on healthcare, accounting for over 17 percent of the nation’s gross domestic product (GDP) [1]. Despite this spending, the United States has the lowest life expectancy of the eleven developed nations in the Organization for Economic Co-operation and Development (OECD), and over 30 million Americans remain uninsured [2,3]. There have been significant efforts by healthcare policymakers and administrators, politicians, and insurance companies to try and reduce national healthcare expenditure. One area that has received significant attention (especially during the COVID-19 pandemic) has been the increase in the utilization of telemedicine in hospitals and medical practices across the US. Telemedicine is the use of remote video conferencing to communicate and distribute medical services, interventions, education, and health administration to patients [4]. Research has found these methods to be cost-effective in several medical settings and specialties. Additionally, telehealth can expand healthcare coverage to rural Americans who are otherwise effectively excluded from regular health services. With the potential to improve costs, efficiency, and access, telemedicine is integral to the future of the US healthcare system. There are, however, important roadblocks and limitations of telemedicine that need to be addressed before a digitalized future of patient-provider interactions can become a reality.

EVALUATION OF PATIENTS’ SATISFACTION IN TELEMEDICINE SERVICE QUALITY: A CASE STUDY ON MAIZBHANDERI FOUNDATION, FATIKCHARI, BANGLADESH

Telemedicine provides healthcare services to the patients through the adaptation of a telecommunication system, as opposed to the face-to-face conventional way of visiting a hospital and doctor's chamber. In the new-normal situation during COVID 19, telemedicine is a new way forward in the absence of conventional appointments with doctors to ensure regular health services. It is important to evaluate patients' satisfaction with service qualities and their perception of telemedicine service. The study proposed a conceptual framework based on the e-SERVQUAL model and TAM model to evaluate the service qualities and customers' satisfaction. Data has been collected through a telephone questionnaire survey from the patients through the psychiatric department who have received healthcare services provided by Maizbhanderi Foundation. Data has been analyzed using IBM SPSS Statistics version 23 according to the patients’ responses on the service qualities including responsiveness, reliability, information quality, empathy, ease of use, perceived usefulness, and their satisfaction with the telemedicine service. The study used Spearman Rank Co-relation to evaluate the co-relation of service qualities with customer satisfaction following the conceptual framework of the study. The result shows a positive co-relation of service qualities with customers’ satisfaction. The study will help to determine the customers' satisfaction with service qualities using technology.

Virtual battery storage service using hydropower plant with co-located floating solar and wind generation

Despite the variability in the output, solar photovoltaic installations have steadily increased around the globe. To ensure the scheduled PV power output and reliability, the system should be grid-connected or have storage, of which grid is the cheaper option. Virtual Battery (VB) is the operational concept where utility allows the prosumer to export their surplus PV output to the grid and receive the same energy back from the grid, charging the premium for storage. Instead of using an actual battery, for the utility to store the prosumers’ energy at a lower cost, this paper proposes a concept called a co-located power plant (CLPP), made of existing hydropower plants combined with floating solar PV (FPV) and nearby wind turbines. Since PV and WTs can complement each other in many ways, CLPP can provide the virtual battery service in addition to normal generation. Optimal generation scheduling of the CLPP while facilitating the VB service is presented here. CLPP profit is maximized using stochastic weight trade-off chaotic particle swarm optimization. The VB service increases the CLPP profit by 37.87 percent as compared to regular service, according to test results from a modified IEEE 24-bus system. From the perspective of the prosumer, VB offers a cheaper storage than battery energy storage, and doubling the profit.

Clinical pharmacists\u2019 interventions across German hospitals: results from a repetitive cross-sectional study

Background Pharmacists’ interventions (PI) are suitable to improve medication safety and optimise patient outcome. However, in Germany, clinical pharmacy services are not yet available nationwide. Aim To gain prospective data on the extent and the composition of routine PI with special focus on intervention rates among German hospital pharmacists during two intervention weeks. Methods Within a repetitive cross-sectional study, clinical pharmacists documented all PIs on five days during a one-month period (intervention week) in 2017 and 2019 using the validated online-database ADKA-DokuPIK. Additionally, data regarding the supply structure/level of medical care, the extent of clinical pharmacy services and their professional experience were collected. All data were anonymised before analysis. Results In total, 2,282 PI from 62 pharmacists (2017) and 2578 PI from 52 pharmacists (2019) were entered. Intervention rate increased from 27.5 PI/100 patient days in 2017 to 38.5 PI/100 patient days in 2019 (p = 0.0097). Frequency of clinical pharmacy services on a daily basis significantly increased from 60% (2017) to 83% (2019). Reasons for PIs from the categories “drugs” (e.g. indication, choice, documentation/transcription) and “dose” were most common in both intervention weeks. The vast majority of underlying medication errors in both intervention weeks were categorised as “error, no harm” (80.3 vs. 78.6%), while the proportion of errors which did not reach the patient, doubled to 39.8% in IW-2019. Conclusion Regular and daily clinical pharmacy services become more established in Germany and clinical pharmacists are increasingly involved in solving drug related problems proactively and early during the medication management process.

Paying with your data. Privacy tradeoffs in ride-hailing services

ABSTRACT We carried out a discrete choice experiment to test users’ readiness to co-finance a ride-hailing service using their personal data. We designed an experiment in which respondents were asked to choose between a regular service and hypothetical app-based taxi rides offering discounts in exchange for respondents consenting to their personal data being shared. Our analysis compared how awareness of rights stemming from the GDPR affects respondents’ privacy preferences. Cross-group analysis indicated that reminding users about their rights stemming from the GDPR significantly increases the value they ascribe to protection of personal data. The results of WTA analysis suggest that there is a market for ‘pay with your data’ business models.

The Experience of Key Stakeholders During the Implementation and Use of Trauma Therapy via Digital Health for Military, Veteran, and Public Safety Personnel: Qualitative Thematic Analysis.

BackgroundExposure to occupational stressors and potentially psychologically traumatic events experienced by public safety personnel (eg, paramedics, police, fire, and correctional officers), military members, and veterans can lead to the development of posttraumatic stress injuries and other mental health disorders. Providing emergency services during COVID-19 has intensified the challenges. Owing to COVID-19 restrictions, mental health service providers offering support to these populations have had to rapidly pivot to use digital versus in-person methods of service delivery.ObjectiveThis paper aims to explore the experience of mental health service providers regarding digital health service delivery, including the current state of digital mental health service delivery, barriers to and facilitators of the use of digital health for mental health service delivery experienced during the pandemic, and recommendations for implementing and integrating digital health into regular mental health service delivery.MethodsThis embedded mixed-methods study included questionnaires and focus groups with key stakeholders (N=31) with knowledge and experience in providing mental health services. Data analysis included descriptive, quantitative, and qualitative thematic analyses.ResultsThe following three themes emerged: being forced into change, daring to deliver mental health services using digital health, and future possibilities offered by digital health. In each theme, participants’ responses reflected their perceptions of service providers, organizations, and clients. The findings offer considerations regarding for whom and at what point in treatment digital health delivery is appropriate; recommendations for training, support, resources, and guidelines for digitally delivering trauma therapy; and a better understanding of factors influencing mental health service providers’ perceptions and acceptance of digital health for mental health service delivery.ConclusionsThe results indicate the implementation of digital health for mental health service delivery to military members, public safety personnel, and veterans. As the COVID-19 pandemic continues, remote service delivery methods for trauma therapy are urgently needed to support the well-being of those who have served and continue to serve.

The Relationship between Passengers' Satisfaction of Urban Road Transport Services and Their Sense of Belonging

Passengers' satisfaction of urban road transportation services has been widely researched over the past few decades. However, no study has been conducted to analyze the relationship of the passengers' satisfaction of regular taxi and bus transport services with an external psychological factor. To this end, 100 passengers were randomly recruited to participate in this study. The participants were required to complete three questionnaires to assess their level of belonging and their satisfaction of regular taxi and bus transport services as two prominent urban road transport services. The questionnaire of sense of belonging had 12 items rated on a 5-point Likert Scale. The responses also were rated from “strongly disagree” to “strongly agree”. The respondents were requested to grade 1 to 10 an 18-travel-attribute survey to assess their satisfaction of urban road transport services. The results indicated that passengers were not satisfied with urban road transport services; however, their satisfaction with regular taxi was higher in comparison with bus transport services. The findings also revealed that there was a significant correlation between the passengers' level of belonging and their satisfaction of public transport services.

A Secure Link-Layer Connectivity Platform for Multi-Site NFV Services

Network Functions Virtualization (NFV) is a key technology for network automation and has been instrumental to materialize the disruptive view of 5G and beyond mobile networks. In particular, 5G embraces NFV to support the automated and agile provision of telecommunication and vertical services as a composition of versatile virtualized components, referred to as Virtual Network Functions (VNFs). It provides a high degree of flexibility in placing these components on distributed NFV infrastructures (e.g., at the network edge, close to end users). Still, this flexibility creates new challenges in terms of VNF connectivity. To address these challenges, we introduce a novel secure link-layer connectivity platform, L2S. Our solution can automatically be deployed and configured as a regular multi-site NFV service, providing the abstraction of a layer-2 switch that offers link-layer connectivity to VNFs deployed on remote NFV sites. Inter-site communications are effectively protected using existing security solutions and protocols, such as IP security (IPsec). We have developed a functional prototype of L2S using open-source software technologies. Our evaluation results indicate that this prototype can perform IP tunneling and cryptographic operations at Gb/s data rates. Finally, we have validated L2S using a multi-site NFV ecosystem at the Telefonica Open Network Innovation Centre (5TONIC), using our solution to support a multicast-based IP television service.

The effectiveness of private services in public hospitals: The case of St. Paul Hospital, Addis Ababa, Ethiopia

BackgroundRetention of doctors had been a big challenge for Ethiopian public hospitals. Private wing service in public hospitals was established in Ethiopia in 2009 with major objectives of retaining specialist doctors and improving access to health services. ObjectiveThis study was conducted to assess the effectiveness of the private wing services in St. Paul Hospital. MethodsQualitative and quantitative data were collected in January 2016. Focus group discussions, key informant interviews and documents review were conducted. A total of 37 participants were included in the study. The discussions and interviews were conducted with specialist doctors, nurses, anesthetists and members of the hospital management team. Consent was obtained from all participants before the data collection. All data were transcribed verbatim, typed and stored safely. Then content and thematic analysis was conducted. ResultsMost of the participants agreed that the private wing arrangement had contributed to the motivation and retention of specialist doctors most notably the surgeons in the hospital. The number of specialist doctors in the hospital increased over the 6 years after the establishment of the private wing by 223%. Most participants mentioned that the hospital benefitted from the private wing. The number of major surgeries conducted in the regular service of the hospital increased by four folds over the six years. In the same period, a total of 8,975,967 ETB was generated to the hospital. ConclusionThe private wing in St. Paul hospital was successful as it contributed to the retention and motivation of specialist doctors and improved access to health services. Other public hospitals may consider establishing private wing services.

UK veterans’ mental health and well-being before and during the COVID-19 pandemic: a longitudinal cohort study

ObjectiveTo investigate the impact of the COVID-19 pandemic on the health and well-being of UK ex-service personnel (veterans) before and during the pandemic, and to assess associations of COVID-19 experiences...

Telepharmacy: A Potential Alternative Approach for Diabetic Patients During the COVID-19 Pandemic.

The use of telepharmacy technology allows pharmacists to provide clinical pharmaceutical services to patients with diabetes mellitus (DM) who need regular services during the COVID-19 pandemic while maintaining distance and minimizing face-to-face meetings. The purpose of this review article was to identify the impact of telepharmacy intervention by pharmacists in diabetic patients by reviewing clinical outcomes and patient therapy adherences. A literature search was conducted through the PubMed database using the terms “telemedicine”, “telepharmacy”, “telehealth” and “telephone” in combination with “pharmacist”, ‘diabetes’ and ‘COVID-19ʹ or “Pandemic”. From a total of 67 articles identified, 14 research articles conform to the inclusion criteria. Telephone is the most widely used communication model (n = 11). All studies had a positive impact on clinical outcomes and three studies did not provide significant result on therapy adherence. The use of telepharmacy can be maximized and used on a vast scale, with the design of devices and technologies making it easier for pharmacists and diabetic patients to provide and receive clinical pharmaceutical services during the COVID-19 pandemic.

Coronavirus disease 2019 in Egypt

Since the first discovery of clusters of coronavirus disease 2019 (COVID-19)-infected patients in China, Egypt designed strategies and action plans to face COVID-19 challenges on the health care system, as well as at economic and social levels. The Ministry of Health and Population regulates the health care system capacity with a mounting strategy to avoid the collapse in health care system capacity and to maintain the regular health services; the COVID-19 taskforces include many connecting pillars such as command and control center, triage hospitals, PCR chain, isolation hospitals, contact tracing team, and ambulance fleet. Egypt adheres to competent health and protective measures while reopening the economic activities; on the contrary, an important step was taken in designing many clinical trials and sharing in vaccine trials while raising the capacity for potential vaccine production.

Telemedicine: expected challenges in Chile based on the experience in the United States during the pandemic

Telemedicine has had a significant role during the outbreak of COVID-19. The experience in the United States has shown advantages and some challenges that need to be addressed to include telemedicine as an established part of the health system. This article aims to determine the United States' main challenges, associating them with the Chilean reality. In this study, we classify the barriers and difficulties for telemedicine into three areas: accessibility, cyber security, and medical liability.We argue that Chile will have to deal with similar obstacles to include telemedicine as a regular health service for the entire population.