Seeking Health Care Research Articles

PATHWAYS OF CARE: THE EXPERIENCE AND COSTS OF CARING FOR FAMILY MEMBERS LIVING WITH DEMENTIA IN MEXICO

Abstract Introduction Formal health and social security institutions are not unequipped to respond to significant dementia prevalence, and currently, no publicly funded national level dementia care policies are in place. However, little is known about the economic, social and health consequences for those providing care. Methods This paper presents families’ health and social dementia care seeking trajectories and the structural factors that shape them. It is based on results of almost 2 years of highly inductive fieldwork, carried out before and during the ongoing COVID-19 pandemic, and includes 50 in-depth interviews with 23 unpaid family caregivers. Results Lack of awareness and knowledge about dementia and normalization of cognitive impairment as part of aging result in long delays in seeking care. When there is a diagnosis, health professionals concentrate on clinical aspects of illness, but seldom explain possible changes, behaviours, symptoms, or provide care strategies. For most carers, high opportunity costs are reported with high impact as they stop or change to more flexible employment, change living arrangements, in addition to the large economic impact of paying for most care inputs such as medicines or home adaptations. Conclusions In Mexico, these unpaid family carers struggle to navigate complicated care pathways, with little or no government or public support. Health system institutions should increase awareness and knowledge about dementia and prioritize developing and coordinating programs that provide timely diagnosis within primary care services and support strategies for people living with dementia and their carers, using person centred care.

HEALTHCARE-SEEKING BEHAVIORS AMONG OLDER AMERICANS WITH SUBJECTIVE COGNITIVE DECLINE

Abstract Subjective cognitive decline (SCD) in older adults is increasingly recognized as a harbinger of dementia. However, since SCD is, by definition, based on self-reports, it is unclear whether those who experience memory loss discuss these issues with physicians. Access to regular healthcare can be a catalyst for early detection of SCD because asymptomatic cognitive changes may not be apparent unless directly addressed with primary care physicians (PCP). Further, given the widely-known racial/ethnic disparities in healthcare access, minority adults might be further disadvantaged in healthcare seeking for SCD. Using a large national dataset, Behavioral Risk Factor Surveillance System (BRFSS) in 2019, the goals of the study are to a) examine the link between having a PCP and discussing memory issues with physicians and b) examine how race and ethnicity and the availability of PCPs are associated with discussion of SCD. The sample included 7,900 individuals 50 and older who reported SCD in the past year. We conducted a logistic regression adjusting for BRFSS survey weights, missing data, state-level clustering, and a set of covariates. Among those with SCD, those with a PCP were almost twice as likely to discuss their cognitive decline (OR=1.98, p<.001). There was also a significant interaction between Hispanic ethnicity and having a PCP (OR=0.25, p<.05, F=4.65, p=.03). Surprisingly, Hispanics with a PCP were less likely to discuss memory issues compared to Hispanics without one. The findings highlight the significance of routine healthcare service utilization for adults with SCD while providing a nuanced understanding of ethnic differences.

Regional differences in patient-reported outcomes as a proxy of healthcare practices for Americans living with vestibular symptoms.

Geographical location is known to affect health outcomes; however, evidence regarding whether location affects healthcare for persons suspected to have vestibular dysfunction is lacking. To investigate whether location affects healthcare seeking and outcomes for adults with symptoms of vestibular pathology. We assessed for regional disparities associated with demographics, diagnosis, chronological factors, and financial expenditures from Americans who participated in the Vestibular Disorders Association registry (N = 905, 57.4±12.5 years, 82.7% female, 94.8% White, and 8.1% Hispanic or Latino). Respondents were grouped per geographical regions defined by the United States Census Bureau. There were no significant between-region differences for age (p = 0.10), sex (p = 0.78), or ethnicity (p = 0.24). There were more Asian respondents in the West versus the Midwest (p = 0.05) and more Black respondents in the South versus the West (p = 0.05). The time to first seek care was shorter in the Northeast (17.3 [SD = 49.5] weeks) versus the South (42.4 [SD = 83.7] weeks), p = 0.015. The time from the first healthcare visit to receiving a final diagnosis was shorter in the Northeast (46.5 [SD = 75.4] weeks) versus the South (68.9 [SD = 89.7] weeks), p = 0.015. Compared to the Midwest, fewer respondents in the Northeast reported "no" out-of-pocket financial impact, p = 0.039. Geographical location affects healthcare seeking and outcomes for persons suspected to have vestibular dysfunction.

Health insurance: Uptake, perception and its determinants among health care seekers at a tertiary care hospital in Lucknow, India

Health Insurance has come to the forefront of Public Health Policy with the launch of Ayushman Bharat. Government spending on health is dismal compared to other countries, even within the same income bracket, and health insurance is being proposed as the way out. Although health insurance is not a new concept, people are still unfamiliar with it. Hence, the present study was conducted to assess the utilization, awareness and perception regarding health insurance policies in patients attending OPD at a Tertiary Care Hospital.It was a cross-sectional study carried out among the patients attending the outpatient department of a Tertiary Care Hospital, Lucknow from October 2020 to January 2021. Study participants were interviewed using a semi-structured questionnaire. The data obtained were analyzed using SPSS version 26. Though the majority (84.3%) of the participants had heard about the existence of health insurance policies, only one-third (33.6%) of the participants were covered under health insurance policy. Inadequate knowledge regarding benefits, low income, preference for other investments, and no felt need were some of the barriers to subscription.Inadequate knowledge regarding health insurance among health care seekers is a major roadblock in the government's ambitious project of Ayushman Bharat and other health insurance schemes. Emphasis should be given to educating the people regarding their rights and the benefits of health insurance.

Chronic Disease Screening and Health Promotion Strategies for Older Men

The population of older men is increasing. Care of male patients has often been overlooked in practice and research. Older men have increased rates of cardiovascular disease, undiagnosed depression, and suicide, and avoid scheduling routine health visits or delay seeking health care. Nurse practitioners can use evidence-based screening recommendations to identify, treat, and manage chronic conditions in older men to improve their overall health and life expectancy. This report focuses on chronic conditions in older men with high rates of morbidity and mortality and provides updated guidelines to assist nurse practitioners to provide optimal care of their older male patients.

Early Health Care Seeking and Associated Factors Among Patients with Sexually Transmitted Infections in Public Health Facilities of Assosa Zone, Benishangul Gumuz, Western Ethiopia, 2022; Cross sectional study

Background: Majority of STIs are curable, but a number of social and behavioral factors prevent from seeking healthcare treatment timely, which increases the burden of untreated infection. Thus, activities people do when they have symptoms or suspect they have STI has a big impact on disease transmission and control. Delays in seeking treatment for STIs after symptom recognition can increase the incidence of disease. Objective: To assess the magnitude of early health care seeking and associated factors among patients with sexually transmitted infections in public health facilities of Assosa Zone, Ethiopia, 2022. Method: An institution -based cross-sectional study was employed to collect data from 416 STI patients from May 15 to July 15, 2022. Data were collected using a pretested structured interviewer- administered questionnaire. A systematic sampling method was used to select study participants. Binary logistic regression analysis was used to identify factors associated with early health-seeking. Result: From total sample patients, 404 (97.12%) were successfully interviewed. From them 40.1% [95%CI (35.4, 44.9%)] of study participants seek health care early within 7 days. secondary educational level [AOR =0.45; 95% CI (0.23,0.90)], had good knowledge about STI [AOR =2.27; 95% CI (1.28,4.02)], perceived the severity of STI [AOR=2.24; 95%CI (1.19,4.21)], those who had fear of stigma for STI [AOR=0.40;95%CI (0.24,0.66)] and had single sexual partners [AOR=2.19; 95%CI (1.20,3.99)] were significantly associated with early of health care seeking for sexually transmitted infections. Conclusion: Lower than half of the study participants seek care early within seven days of onset of symptoms. Indepth health education is essential to raise awareness, avoid risky behaviors, and alter negative perceptions

Health Care Financing and Financial Hardship among Rural and Urban Households in Ekiti State, Nigeria

Background: Individuals and families suffer financial hardship in seeking health care. The study aimed to assess health care financing and experience of financial hardship in seeking health care among urban and rural households in Ekiti State, Nigeria.
 Methods: This was a comparative, cross-sectional study. A multi-stage sampling technique was used to select 420 households each in the rural and urban areas. Data was collected using pre-tested, structured interviewer-administered questionnaire, and analysed using SPSS v20. Level of statistically significance was set at p-value of <0.05.
 Results: One hundred and seventy-nine respondents (42.6%) in the rural area, and 156 (37.1%) in the urban area had experienced difficulty in paying for health bills (p=0.105). Respondents who have had to borrow recently for seeking healthcare were 129 (30.7%) in the rural area, and 131 (31.2%) in the urban area (p=0.881), while 47 (11.2%) in the rural area, and 43 (10.2%) in the urban area have had to sell household assets (p=0.655). Out-of-Pocket was the main method of healthcare financing for the majority, 410 (97.6%) in the rural areas, and 400 (95.2%) in the urban areas. Only 10 (2.4%) of the ruralrespondents and 20 (4.8%) of the urban respondents were on health insurance.
 Conclusion: A high proportion of the study population experienced financial hardship and there is high dependence on out-of-pocket financing. This calls for increased community mobilization and acceleration of the progression of health insurance towards universal coverage in Ekiti State.

Accessibility audit of a health care institute in India: Are people with disabilities being provided their rights?

BackgroundPoor accessibility of health care facilities is a major barrier for differently abled people when seeking health care. Yet, accessibility is rarely audited. This study reports findings from the first assessment of the accessibility in a health care institution of national importance. This study also assumes importance from various laws and legislation that assure equality and rights for people with disabilities (PWDs). Keeping the objectives in mind, this study was performed with an aim to study the situational analysis of the health institution of national importance for assessing the compliance of hospital premises for being disabled friendly, to find any lacunae, and to suggest remedial measures based on the study finding. The aim was to conduct a content and quality review of research into the hospital experiences of PWD and to identify gaps. MethodsThis was a hospital-based cross sectional study done in a period of 30 days. The gap analysis was performed with validated checklist provided by Central Public Works Department, Government of India (CPWD). ResultsOut of total 126 pointers, 45 pointers were found to be totally compliant, 30 pointers were found to be partially compliant, and remaining 51 pointers were found to be not applicable to the hospitals. ConclusionThis assessment of the accessibility of health care facilities showed that that it is feasible to undertake these audits on a large scale, and these audits should be repeated in other settings. It highlights important gaps in accessibility, increasing the risk of the violation of the right to health of PWDs.

Evaluation of Serum Calcitonin, Creatinine and Uric Acid in Ckd Complicated By Dysthyroidism

This study evaluated the serum calcitonin, creatinine and uric acid levels in chronic kidney diseases (CKD) complicated by dysthyroidism. A total of 119 participants were recruited in this study, majority of who were males. This may likely be as a result of the bread winning role of men and hence are often economically empowered to seek health care. The higher proportion of males in this study could reflect a positive change in health seeking behavior of the male gender. Majority of the participants in this study were between the ages of 30 to 68 years with a median of 49 years. The high prevalence of CKD among this age group can be attributed to underlying pathologies such as hypertension, diabetes or both. Result from this study showed a significant increase (p ≤ 0.05) in serum calcitonin,TSH, creatinine and uric acid levels of CKD subjects when compared to the control and a significant decrease (p ≤ 0.05) was observed in serum T3 and T4 levels of CKD subjects were observed.T3 value showed significant decrease when the value of T3 gotten from stage 3,4 and 5 of CKD subjects were compared.

Medical doctors do not know it, nor can they treat it: Identifying the common neonatal illnesses and preferred healthcare practices in a Yoruba community, Nigeria

Background: Prompt and effective healthcare practice is essential to reducing neonatal morbidity and mortality which is at a higher rate among low-income nations including Nigeria, especially in rural settings. Studies have identified some structural factors such as poverty and limited healthcare resources as major factors without giving adequate attention to the related intrinsic factors such as peoples‟ understanding and beliefs among other cultural factors that could encourage or hinder effective healthcare practices for the neonates which is the gap of this study intends to fill. Methods: First-hand data were collected during a six-month rapid ethnographic fieldwork at Akinlalu using various qualitative methods of data collection including observations, interviews, and discussion among others. The main focuses were the community's social life and activities and socio-cultural structures such as faith homes and healthcare as well as individuals (grandmothers, grandfathers, birth attendants, medical doctors, and childbearing fathers and mothers) involved in family and children's health in this community. Results: Findings reveal an array of neonatal illnesses and interestingly a high level of discordance between the perceived illnesses, causes, and treatment between local people and modern healthcare providers. Widely identified and considered the deadliest neonatal diseases are senukoto, oka, and yiyi (measles). Others mentioned are giri (convulsion), olo-inu, and jedi-jedi. Senukoto is believed to be caused by kokoro (bacteria/germs) and can kill the infected neonate within the first seven days after birth if not adequately treated. Oka, yiiyi, and olo-inu were also considered deadly, usually causing taboos violation while eating sweetening things during pregnancy or breastfeeding is the perceived cause of jedi-jedi. Conclusion: the study concludes that rural dwellers often cast doubt on orthodox medical practitioners in response to childhood illnesses and treatment which in most cases have implications for prompt healthcare seeking and non-adherence to the medically prescribed regimen.

Prevalence of essential newborn care in home and facility births in the Peruvian Amazon: analysis of census data from programme evaluation in three remote districts of the Loreto region

Essential newborn care (ENC) covers optimal breastfeeding, thermal care, and hygienic cord care. These practices are fundamental to save newborn lives. Despite neonatal mortality remaining high in some parts of Peru, no comprehensive data on ENC is available. We sought to estimate the prevalence of ENC and assess differences between facility and home births in the remote Peruvian Amazon. We used baseline data from a household census of rural communities of three districts in Loreto region, collected as part of the evaluation of a maternal-neonatal health (MNH) programme. Women between 15 and 49 years with a live birth in the last 12 months were invited to complete a questionnaire about MNH-related care and ENC. Prevalence of ENC was calculated for all births and disaggregated by place of birth. Adjusted prevalence differences (PD) were post-estimated from logistic regression models on the effect of place of birth on ENC. All 79 rural communities with a population of 14,474 were censused. Among 324 (>99%) women interviewed, 70% gave birth at home, most (93%) without skilled birth assistance. Among all births, prevalence was lowest for immediate skin-to-skin contact (24%), colostrum feeding (47%), and early breastfeeding (64%). ENC was consistently lower in home compared to facility births. After adjusting for confounders, largest PD were found for immediate skin-to-skin contact (50% [95% CI: 38-62]), colostrum feeding (26% [16-36]), and clean cord care (23% [14-32]). ENC prevalence in facilities ranged between 58 and 93%; delayed bathing was lower compared to home births (-19% [-31 to-7]). Low prevalence of ENC practices among home births in a setting with high neonatal mortality and difficult access to quality care in facilities suggests potential for a community-based intervention to promote ENC practices at home, along with promotion of healthcare seeking and simultaneous strengthening of routine facility care. Grand Challenges Canada and Peruvian National Council of Science, Technology, and Technology Innovation.

Impact of Female Stress Urinary Incontinence on Quality of Life, Mental Health, Work Limitation, and Healthcare Seeking in China, Taiwan, and South Korea (LUTS Asia): Results from a Cross-Sectional, Population-Based Study.

Stress urinary incontinence (SUI) is common among adult women with negative effects on psychosocial well-being, mental health, and health-related quality of life. The purpose of the research is to determine if SUI in women is a factor implicated in changes in health-related quality of life (HRQoL) in both physical and mental health domains and in work difficulties. Data of women 40 years or older from a cross-sectional, population-based, internet survey were examined post-hoc. The effect of SUI frequency on HRQoL (SF12 score), in physical and mental health domains, was assessed. In addition, multivariate and univariate analyses were used to show the influence of SUI on HADS (Hospital Anxiety and Depression Scale) depression score and HADS anxiety score. The effects of demographic factors and physical ailments and SUI on work difficulties were similarly analyzed using multivariate logistic regression. A total of 4208 women with mean age of 60 were included in the analysis. The more frequent SUI episodes were associated with a greater reduction of HRQoL in both physical and mental health domains. In addition, both multivariate and univariate analyses showed that SUI could be correlated with a negative effect on HADS anxiety score (OR 1.617, CI 1.335-1.958, p=0.000) and HADS depression score (OR 1.263, CI 1.044-1.527, p=0.016). Univariate analyses suggested that work difficulties were correlated with SUI. Available data revealed that many sufferers, including up to 40% of individuals with SUI frequency rating 1 (less than once a month) to 3 (a few times a week), failed to seek treatment. SUI, common in women ≥40 years of age, impairs quality of life in both physical and mental health domains. SUI is an independent risk factor for anxiety and depression and has been linked to significant work dysfunctions. This study is registered at ClinicalTrials.gov: NCT02618421 (Date of registration: December 1, 2015).

Determinants of inequality in health care seeking for childhood illnesses: insights from Nairobi informal settlements

BackgroundAn in-depth understanding of patterns of inequities in healthcare seeking among the urban residents is critical in identifying appropriate interventions strategies. The study evaluates determinants of inequality in health care seeking for childhood illnesses among informal settlement residents in Nairobi, Kenya. MethodsData from the second Nairobi Cross-Sectional Slum Survey (NCSS 2012) was examined. The inequality in seeking health care for childhood diarrhea as the prototype illness was assessed using concentration index (CI). The wealth index based on the household possessions and amenities was used as a measure for socioeconomic status. ResultsA total of 2 027 qualified women were included in this study. About 16.6% of children born of younger mothers aged < 20 years had diarrhea and a similar proportion of children (16.3%) was observed among mothers who were unemployed. The CI of −0.026 on health care seeking for diarrhea among children points to significant inequality among the urban poor (95% confidence interval: −0.028 to −0.023). ConclusionOccupation of parents, age of mothers, ethnicity, marital status and children's age were major determinants with regard to disease outcome and to a broader extent inequality in health care seeking for childhood illnesses. Enhanced bottom top community health invigoration strategies in health information awareness and services access would be instrumental.

Application of 3D Printing Technology in the Medical Field

Background: 3D printing technology is widely used, with its application majorly prevailing in the medical field. Objective: In this paper, the applications of 3D printing technology in the medical field are classified and summarized, and their characteristics are introduced. Methods: This paper mainly summarizes the contribution of 3D printing technology to the field of medicine, as well as four applications of 3D printing technology in medicine, and also introduces some examples of clinical application of 3D printing. Results: 3D printing has proved to be an emerging art and a new innovation. It has a variety of different medical applications. Because of its limitations, it is not routinely used in clinical practice. However, it will be open to the public in the near future due to technological advances. It will provide new opportunities for every healthcare provider and seeker, and it will become a modern technology for innovative medical practices. Conclusion: 3D printing technology has been significantly developed and applied to oral cavity, implants and even human organs in the medical field，and shows a vigorous development trend. It is believed that this technology will significantly benefit mankind in the future.

Health literacy interventions for reducing the use of primary and emergency services for minor health problems: a systematic review

Background Health literacy is the ability to find information, understand information, know how to act on information and know which services to use. Having higher levels of health literacy may help patients to look after minor problems themselves (self-care). It may also help to reduce patients’ perceived need for contacting health services for minor health problems, to reduce the perceived urgency of problems or to improve patients’ ability to identify and choose from the range of available services. Interventions to improve health literacy for minor health problems have been evaluated, but their effectiveness at reducing use of primary care and emergency services has not been synthesised. Objectives The key objectives were as follows: (1) to construct a typology of interventions that aim to reduce primary or emergency care use, (2) to synthesise evidence of the effectiveness of different types of health literacy interventions and (3) to consider how stakeholders in the UK could operationalise the evidence. Interventions The interventions being reviewed were initiatives that help members of the population to self-care or make decisions about whether or not and where to seek health care for minor health problems. Design This study was a systematic review with stakeholder involvement. Data sources and review methods A meeting was held with 14 stakeholders (including patients, carers and the public) to guide the systematic review. This was followed by a multicomponent review of quantitative and qualitative research. Database literature searches were undertaken in Ovid MEDLINE, The Cochrane Library (via Wiley Interscience), EMBASE (via OVID), the Cumulative Index to Nursing and Allied Health Literature (via EBSCO), PsycINFO (via OVID), Web of Science and Sociological Abstracts. The search was limited to English-language publications from 1990–2020. To assess study quality, the Cochrane Risk of Bias tool was used for randomised controlled trials and the Newcastle–Ottawa Scale was used for non-randomised studies. A narrative synthesis was undertaken. The review was followed by a meeting with 16 stakeholders to interpret the results. Results A total of 67 articles (64 studies) were included: 37 from the USA, 16 from the UK, 12 from the rest of Europe and two from the rest of the world. There were seven intervention types: navigation tools directing people to the range of services available (n = 7); written education about managing minor health problems in booklet or website format (n = 17); person-delivered education (n = 5); written education with person-delivered education (n = 17); multicomponent of written education, person-delivered education and mass media campaign (n = 5); self-triage (n = 9); and other (n = 7). Our team assessed the readability and user-friendliness of interventions, and found that these varied widely. When assessed, most studies measuring satisfaction with the intervention, enablement and perceived changes to behaviour showed positive results. Of 30 articles reporting impact on emergency department attendances, 19 (63%) showed a reduction, and 16/27 (59%) articles measuring impact on general practice consultations showed a reduction. Variation in the evidence base was not explained by any research, context or intervention characteristics. Only eight articles measured safety: these identified no problems. Limitations There was inconsistency in how the outcomes were measured, so a meta-analysis was not possible. Conclusions Health literacy interventions have potential to affect emergency and primary care use, but the evidence base is inconsistent. Future research It is important to continue to evaluate these types of initiatives. Study registration This study is registered as PROSPERO CRD42020214206. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 38. See the NIHR Journals Library website for further project information.

Therapeutic itineraries according to the narratives of parents of children with disabilities secondary to neurodevelopmental disorders.

Childhood neurodevelopmental disorders account for 10% of the causes of childhood disability. The search for medical care leads to therapeutic itineraries routes taken by individuals to seek health care where diagnostic and treatment opportunities arise. Our objective was to explore these itineraries in order to understand the opportunities and barriers to the implementation of therapies and child rearing patterns promoting neurodevelopment. Qualitative study using in-depth interviews with children's parents (between June 2018 and November 2019). The analysis was based on the social model of disability and Vygotsky's approach to child development. A total of 16 interviews were conducted. Considering the time of diagnosis and the age when the therapeutic itinerary started, 2 groups were identified: those who started from birth to 2 years old (early initiation) and those who started from 3 years old (late childhood initiation). In the first group, the search for treatment starts at an early stage, while in the other group, decisions on the initiation and/or type of treatments are prolonged over time. Late initiation was accompanied by difficulties in school, periods of uncertainty, distress and/or family conflicts due to the complexities of parenting. Therapeutic itineraries started early in some cases and at a later stage in others. The initiation of treatments made it possible to use tools to bridge the gap of discrepancies between the biological and cultural lines of development.

Prostate Cancer Disparities and Management in Southern Africa: Insights into Practices, Norms and Values.

Prostate cancer (PCa) is a leading cause of mortality in men of African origin. While men of African descent in high-income countries (HICs) demonstrate poor prognosis compared to their European counterparts, African men on the African continent, particularly Southern Africa have shown even higher PCa mortality rates. Extrinsic factors such as the socioeconomic status, education level, income level, geographic location and race contribute to PCa patient outcome. These are further deepened by the African norms which are highly esteemed and may have detrimental effects on PCa patients' health. Insights into African cultures and social constructs have been identified as key elements towards improving men's health care seeking behaviour which will in turn improve PCa patients' outcome. Compared to Southern Africa, the Eastern, Western and Central African regions have lower PCa incidence rates but higher mortality rates. The availability of cancer medical equipment has also been reported to be disproportionate in Africa, with most cancer resources in Northern and Southern Africa. Even within Southern Africa, cancer management resources are unevenly available where one country must access PCa specialised care in the neighbouring countries. While PCa seems to be better managed in HICs, steps towards effective PCa management are urgently needed in Africa, as this continent represents a significant portion of low-middle-income countries (LMICs). Replacing African men in Africa with African American men may not optimally resolve PCa challenges in Africa. Adopting western PCa management practices can be optimised by integrating improved core-African norms. The aim of this review is to discuss PCa disparities in Africa, deliberate on the significance of integrating African norms around masculinity and discuss challenges and opportunities towards effective PCa care in Africa, particularly in Southern Africa.

A scoping review of the healthcare provided by nurses to people experiencing domestic violence in primary health care settings.

Domestic and family violence is a significant and growing public health concern in many communities around the world. Nurses are often the first and sometimes only point of contact for people seeking healthcare following DFV incidents and are therefore well placed to identify and support these vulnerable people. The aim of this scoping review is to examine the English language studies of healthcare provided by nurses in primary healthcare settings to people experiencing domestic and family violence. A scoping review of the following databases was undertaken between March-June 2021: CINAHL, Medline, and PubMed. Primary studies were included if written in English, published from 2000 onwards, and focused on the care provided by primary healthcare nurses to people experiencing DFV. A critical appraisal of included studies was conducted using the Mixed Methods Appraisal Tool (MMAT). Results were synthesised narratively. Six studies were included, from the United States (n=2), United Kingdom (n=1), Sweden (n=2), and Brazil (n=1). Five studies were quantitative and one qualitative. A fundamental aspect of the healthcare provided by nurses, reported by all studies, was the screening of DFV. Other healthcare provided includes physical and mental health assessment and referral to other services, including sexual assault clinics, social supports, and law enforcement agencies. Findings suggest the level of DFV screening conducted by nurses is limited. Nurses' knowledge of how to support people experiencing DFV was also reportedly limited. Two studies reported that nurses were unfamiliar with DFV practice guidelines and the existence and availability of support networks for people experiencing DFV. Findings suggest inconsistency in primary healthcare nurses' level of education, skill and knowledge, and detection of people experiencing DFV. As the largest healthcare professional discipline, nurses have frequent contact with people experiencing DFV. There is an urgent need for nurses to be better educationally prepared and more organisationally supported in order to adequately respond and provide healthcare to people experiencing DFV. Given that the number of people experiencing DFV has increased due to the COVID-19 pandemic, it is ever more important for nurses to be well equipped to identify and respond appropriately.

Effect of household couple counselling for male involvement on the utilization of postnatal services at 1 week in Ibanda district, Uganda; A cluster randomized community trial

Introduction: Prompt and Skilled postnatal care attendance coupled with skilled Antenatal and delivery care can drastically reduce maternal morbidity and mortality and also improve newborn outcomes. Research shows that men are decision makers in the home but they may also restrict resources, hence preventing women and children from health care seeking. But however if involved men may lead to better health care seeking behavior and better utilization of Antenatal care, delivery and postnatal care services. The postnatal care attendance at 1 week is low in Uganda, Ibanda district reported 4% in 2018. The aim of this study was to innovate, implement and document an intervention of house hold couple counseling for male involvement and compare the intervention and control clusters on the utilization of postnatal care services at 1 week. Methods: This was a two arm cluster randomized Community trial with a parallel design with the aim of comparing utilization of postnatal care services. It was carried out in two intervention parishes and two control parishes and was a superiority trial to test if the intervention of household couple counseling would improve utilization of postnatal care services. Results: The intervention arm had 200 respondents while the control had 213. The mean age was 27.3years (SD 6.8). Ninety one point five percent of mother had used skilled delivery services in the intervention compared to 78.4% in the control. Seventy Five percent attended postnatal care at 1week in the intervention as compared to 21.1% in the control (OR 11.2, P&lt;0.001). The activity that are statistically significantly associated with utilization of postnatal services utilization is providing transport to the postnatal clinic (AOR 30.8, P&lt;0.001) comparing the intervention and control clusters. The others included; accompanying to antenatal clinic, partner attending antenatal clinic, providing transport for delivery, escorting partner for delivery, providing psychological support during delivery and providing necessary drugs during delivery and PNC period but these were not statistically significant. Conclusion: The study demonstrated that the intervention of household couple counseling for increased male partner involvement improved significantly utilization of postnatal care services. Interventions to improve utilization of postnatal care services should focus on involving male partners to do the supportive activities which help their partners utilize the health care services.

Challenges and Neuropsychological Functioning in Children and Adolescents with Borderline Intellectual Functioning.

This retrospective chart review study sought to explore neuropsychological profiles, neuropsychiatric and psychiatric comorbidity, changes in diagnoses, support at daycare and school, medication use, psychiatric referrals, and progression into further education in a cohort of participants with borderline intellectual functioning (BIF). Additionally, developmental factors connected to BIF were studied. Delays in language and gross motor development were the initial reasons for the parents to seek health care. Comorbid neuropsychiatric and psychiatric diagnoses were frequent, a total of 41% of participants were referred to psychiatric services, and 45% used medication. Educational support was needed by 92% of the study participants. The majority of those graduating elementary school continued their studies at ordinary or special vocational schools. The risk of dropping out during secondary studies appeared to increase. The results in most of the neuropsychological subdomains declined over time, and 23% of the participants were later diagnosed with an intellectual disability (ID). The early developmental signs pointing towards BIF and the need for prompt support were a delay in language and motor development, difficulties in executive function, a delay in learning the activities of daily living among children under school age, and difficulties in reading and arithmetic skills and abstract reasoning at school age. It is important to follow up and support individuals with BIF as their risk for being left behind in the society is increased. Also, it would be important to repeat the neuropsychological testing of cognitive and adaptive functions before graduating elementary school as to capture those who meet the ID criteria.