Use Of Services Research Articles

Caregivers’ Perceptions and Willingness to Utilize Telerehabilitation for Outpatient Consultation and Therapy for Pediatric Patients in a COVID-Referral Center in a Developing Country: A Cross-sectional Study

Background. During the COVID-19 pandemic, social isolation and quarantine measures set to control the spread of the infection paved for the increased utilization of virtual methods of consultation and follow-up. Telerehabilitation allows access to rehabilitation services despite distance and makes possible the continuation of rehabilitation services despite the lack of face-to-face interaction. This is difficult for pediatric patients who are dependent on their caregivers for understanding and making decisions regarding their health. Loss of continuity of rehabilitation services led to poorer outcomes in children with disabilities. Although advantageous for them, pediatric patients may not benefit from telerehabilitation if caregivers have negative perceptions of the process and are unwilling to utilize the service. Objectives. This study determined caregivers’ perceptions and willingness to participate in telerehabilitation as a method of outpatient follow-up for pediatric patients admitted to a COVID-referral center in a developing country. Methods. The study utilized a descriptive cross-sectional design. Respondents were adults (≥19 years old) caring for pediatric patients admitted at non-COVID wards of the Philippine General Hospital and who were referred for rehabilitation services. A survey tool adapted from a previous study on willingness to utilize telemedicine among caregivers of pediatric patients was translated into the Filipino language and used in the study. A dataset from Excel was imported in STATA 16 (StataCorp, Texas, USA) and was exhaustively checked for completeness, accuracy, and consistency before analysis. The association between patient characteristics and willingness to utilize telerehabilitation for any app was determined using Pearson’s chi-squared test or Fisher’s exact test, as appropriate. The latter was used when more than 20% of the cells had an expected value of less than or equal to five. A P value of less than 0.05 was considered significant for all tests. Results. Of 123 respondents, 92 (75%) reported willingness to utilize telerehabilitation for outpatient consultation and therapy using video calls or a customized telerehabilitation app when available. Among 31 (25%) respondents who were not willing or unsure of participation, the main reasons identified were preference for face-to-face, lack of financial resources/load, poor connectivity, and doubt about the effectiveness of telerehabilitation.Patients with younger age (Fisher’s exact test, P=0.023), low usage of video call service (Fisher’s exact test, P=0.020), and lack of available devices (Fisher’s exact test, P=0.015) significantly reduced willingness to utilize telerehabilitation. Caregiver age, sex, educational attainment, estimated monthly income, number of devices used, speed of internet connectivity, and technological behaviors did not show statistical significance in association with willingness to participate in telerehabilitation.Most caregivers recognized the usefulness of a service allowing transmission of health data to and from the hospital, consultation with a doctor in case of an emergency, sending of reminders for medical visits and therapy, and provision of a list of home exercises and nutritional recommendations. Telerehabilitation was perceived advantageous, but concerns regarding privacy, trust, lack of human contact, and technological difficulty were also present. Conclusion. With high levels of willingness among caregivers, telerehabilitation is a viable method of providing rehabilitation services for the continuation of management after inpatient admission among pediatric patients. Limitations in its utilization include technological issues including the lack of devices, low level of service use, and slow internet connectivity. Although well perceived as advantageous, there are concerns regarding loss of human contact, difficulty in using technological devices, and trust and privacy issues that may affect utilization.

Utilization of early therapeutic supports by autistic preschoolers in Australia: A cross-sectional study following implementation of the National Disability Insurance Scheme.

There are many types of support for young autistic children and their families, but service use in this population is not well understood. In this study, primary caregivers of autistic preschoolers were surveyed (n = 95) and a selection were then interviewed (n = 19) to understand how early, therapeutic supports were accessed by families in Australia following the establishment of a National Disability Insurance Scheme (NDIS). This article presents the quantitative data from surveys and interviews. Families usually accessed at least two types of support. The most accessed supports were occupational therapy, speech pathology and psychology, with 43% of the sample accessing some other form of support. Multiple linear regression indicated that children's higher level of support need, living in less remote or less socio-economically disadvantaged areas, and high household income were associated with higher numbers of supports accessed. Services tended to follow an individual, clinic-based model and little use of alternative service delivery was reported. The findings indicate that Australian families are accessing a wider range of support types than before the NDIS and children with more substantial autism-related support needs are likely to access a greater number of types of supports. Socio-economic inequities continue to exist and should be addressed.

Digital Risk Management: A Study of How Firms Mitigate Digital Risks and Threats

The banking industry has seen a sharp rise in the use of AI services over the last ten years, which has improved client satisfaction and efficiency. The machine learning (ML), one of artificial intelligence's primary building blocks, has caused a paradigm change in the banking services sector. Every new technology that is introduced carries with it new threats. Finding such hazards is only the first step; you also need to analyse, evaluate, treat, regulate, and keep an eye on them. Risk is characterised by three elements: the possibility of loss, the unpredictability of the result, and the necessity of making a decision. According to this concept, a risk management strategy should be divided into three stages to address risks: planning ahead, carrying out risk management tasks, and maintaining and enhancing risk management. The first two stages could appear self-evident. But it's critical to recognise that risk management is a continuous process that requires constant attention. Continuous risk management is intended to avert issues, enhance product quality, make better use of available resources, and foster teamwork.

"You sit in abubble while the others go about their lives"-perspectives of Ukrainian refugee mothers with children aged 0-3years

Little is known about the situation of Ukrainian parents with children up to the age of three who have fled to Germany since Russia's attack on Ukraine. The aim of the National Center for Early Intervention research project is to explore the perspective of this group on their lives in Germany. This analysis focuses on the burdens and resources of the parents and their knowledge and use of support services. In 17interviews (duration approx. one hour each), parents (16mothers, one father) who had fled from Ukraine to Germany with children up to the age of three were interviewed between October and December 2022, and their answers were qualitatively analyzed using structured content analysis. The interviewees primarily described the psychological stress caused by war and flight, negative emotions such as feelings of loneliness, sadness and lack of motivation, and obstacles to integration as burdens. Resources were primarily networks of Ukrainian- and Russian-speaking people in Germany as well as personal resources such as self-care skills. Supporting services were generally communicated via electronic media. Services for childcare, language courses, and support with health issues were considered particularly useful. Alack of childcare was the most important reason for not taking up other services. The psychological stress of the interviewees indicates aneed for therapy capacities in their native language. Childcare may enable Ukrainians to attend language courses that promote integration. The self-organized networks of the Ukrainian- and Russian-speaking community should be involved in the development of interventions for this target group in aparticipatory manner from the outset.

An online survey of perspectives towards the impact of the covid-19 pandemic amongst caregivers of adolescents with ASD.

The coronavirus disease (COVID-19) pandemic has had a negative impact on the health and mental health of adolescents and adolescents with autism spectrum disorders (ASD) and their caregivers, have been disproportionally affected. The purpose of this study was to investigate the impact of COVID-19 on Thai caregivers and adolescents with ASD. This study used an online survey with closed and free text questions to investigate how the pandemic had impacted on social skills development and psychological variables, and perceived needs for support. The survey link was shared to parents via the Yuwaprasart Withayopathum Child and Adolescent Hospital and the social media platforms of known ASD stakeholder networks in Thailand. Binary logistic regression was used to investigate the relationships between sociodemographic characteristics, service use, and social skills problems experienced by adolescents during the pandemic. Content analysis was applied to analyse free-text data. A total of 376 caregivers of adolescents with ASD aged 10-19 years completed the survey, of which 364 were included in the analysis. In total, 38.7% of caregivers reported that during the pandemic the social skills of their adolescent family member had worsened. Most families reported that they were able to continue to access support from healthcare and educational services, albeit in different ways than pre-pandemic, during the acute stages of the pandemic which benefited the maintenance of ASD symptoms and social skills. Factors identified as reducing the odds of a worsening in social skills during the pandemic included; regular access to treatment for adolescents (odds ratio [OR] = 0.55, confidence interval 95% (CI) 0.32-0.98, p = 0.044), caregivers feeling that they had sufficient support from hospitals (OR = 0.46, 95% CI 0.26-0.81, p = 0.007) and older age of adolescents (OR = 0.53, CI 0.29-0.99, p = 0.047). The qualitative free text comments showed that the caregivers felt that greater information on managing adolescent behaviours, opportunities for adolescents to practice social skills, and the provision of greater emotional support and material assistance from healthcare professionals during the pandemic would have helped them to care for the adolescents with ASD. Regular access to services, support from hospitals during the pandemic and older age in adolescence may have helped prevent the worsening of the social skills problems of adolescents with ASD.

Caregiver Feedback on Services in Children’s Advocacy Centers: How Does it Differ by Caregiver Language and Child Race-Ethnicity, Gender and Age?

ABSTRACT This study analyzed caregiver feedback regarding referrals, service use, and wanting additional services using a standardized survey completed by 1,585 caregivers at 260 Children’s Advocacy Centers. Most caregivers were referred to counseling or support services for their child (84%). Caregivers who completed the survey in Spanish were significantly more likely to receive referral information for themselves, have children use the services, use the services themselves, report being on waiting lists, want additional services for their child, and believe staff could have done something additional compared to caregivers who completed it in English. African American children were significantly less likely to receive referrals, use services and have caregivers want additional services. Spanish-speaking caregivers and African American children warrant more attention to ensure all families’ needs are being addressed.

Sharing in caring: Family caregiving task sharing patterns for older adults in Singapore.

Research on family caregiving for older adults has largely focused on primary caregivers. We identify caregiving task sharing patterns among multiple caregivers, including family members and live-in hired workers. In addition, we investigate caregiver and care-recipient characteristics associated with these patterns. We interviewed 278 primary family caregivers of home-dwelling older adults in Singapore about who provides what assistance across three domains: activities of daily living, health and social services use, and socio-emotional and other needs. Latent class analysis was used to identify caregiving task sharing patterns. Three patterns were identified: a) 'Shared-Diverse' (39%) - multiple caregivers assisting in all three domains, b) 'Shared-Domestic' (32%) - multiple caregivers assisting with activities of daily living and socio-emotional and other needs, and c) 'Solo-Diverse' (29%) - a sole caregiver assisting in all three domains. 'Solo-Diverse' caregivers were less likely to be employed and had higher depressive symptoms relative to 'Shared-Diverse' primary family caregivers. The predominance of caregiving task sharing patterns involving multiple caregivers calls for expansion of research, policies, and programs beyond primary caregivers. Greater attention should be given to how families and live-in hired workers share caregiving tasks for older adults, and how this varies across cultural settings, especially in familial Asian societies. The findings further highlight the vulnerabilities of solo caregivers, whose employment capacity and mental health may be adversely affected by their caregiving duties. Policymakers should ensure that solo caregivers have access to support programs that address their financial and mental health needs.

EGS SO02 - The undifferentiated general surgical take over 10 years: Admissions

Abstract Background Hospital admissions in England and Wales have been increasing over time. This increase has occurred across many specialties, including across the surgical specialties. The aim of this study is to review the undifferentiated emergency general surgical take, with regards to admissions in July 2013 and July 2023, at a District General Hospital to understand the specific pressures on the department and to identify areas in which we could adapt to facilitate these demands. Method Retrospective data regarding admission and re-admission on all patients treated by the emergency general surgical team in July 2013 and July 2023 was collected from electronic notes. If insufficient information was available, patients were excluded from analysis. Results Patient numbers increased by 50% from 2013 to 2023, from 395 to 594. Average length of stay in 2013 was 3.26 days (+/-0.2, p = 0.03), reducing to 2.58 days (+/-0.2, p = 0.03) in 2023. Number of patients admitted overnight has decreased from 74% (n=291/395) in 2013, to 54% (n=324/594) in 2023. Proportion of referrals from ED increased from 48% in 2013, to 69% in 2023. Planned reviews and patients ambulated for surgery the following day has increased from 4% of all patients seen in 2013, to 16% in 2023. Conclusion Volume of patients has increased significantly over this 10-year period. Simultaneously, duration and number of overnight admissions have decreased, alongside increasing use of ambulatory services. This reflects the aims of the Government, and the Royal College of Surgeons, with increasing investment in day-case and ambulatory services. However, without an increase in hospital bed numbers, the rising volume of patients may become difficult to manage.

Telehealth Use and Legal Considerations in Drug Health Services During Pandemics: Systematic Scoping Review.

The COVID-19 pandemic impacted patients with substance use disorder (SUD) more than the general population and resulted in substantially increased emergency department admissions. Routine care of patients attending drug health services during the pandemic transitioned, with telehealth being important in delivering appropriate care. However, telehealth introduces unique risks such as privacy, confidentiality, and data safety. Providing health care through telehealth may fail if the legal impacts are not fully identified and acted on by health professionals. It also poses unintended risks for patients and can result in ineffectiveness, damages, medical negligence, and detracts from the best intentions of governments and health professionals. Understanding the legal framework ensures that medical professionals operate health care through telehealth within the law. Providing health care successfully through telehealth depends on the balance between innovation and legal compliance. By considering these aspects, clinicians and practitioners can provide effective and safe telehealth services during pandemics or any other natural disaster. We aimed to explore the legal impact of autonomy consent, confidentiality, privacy, data security, professional indemnity, and liability when delivering telehealth to patients with SUD. The scoping review also aimed to provide legal, ethical, and clinical considerations to minimize legal risks with using telehealth in drug health service outpatient settings. We performed a scoping review to provide an overview of existing research, statutes, and case laws for the incorporation of clinical, ethical, and legal considerations into telehealth use. Six databases for medical and 6 databases for legal publications were searched, as well as Australian national and selected international regulatory standards. Medical articles published up to June 2022 were included in this review. Our search yielded 1436 publications, 614 abstracts were reviewed, and 80 published studies met the inclusion criteria from 614 legal and medical search results. Current regulations related to technology use in drug health services, relevant cases, and international regulatory standards are discussed. In total, 43 legal documents including 15 statutes, 4 case laws, and 37 medical publications were reviewed. The themes arising from the literature were consent and autonomy (20/80, 25%), confidentiality (8/80, 10%), privacy (8/80, 10%), data security (7/80, 9%), and professional indemnity issues (3/80, 4%) in telehealth use. Further, 24 studies identified legal issues associated with telehealth use in patients with SUD. Our review identified potential legal issues associated with telehealth use in patients with SUD. Several legal and medical research articles provide frameworks, codes of conduct, or suggestions for clinicians to consider, but there was little discussion or evidence of how legal considerations are being applied when providing telehealth consultations at drug health services. Clinicians should be aware of the medicolegal implications when providing health care via telehealth at drug health services.

Identifying and prioritizing inefficiency causes in Iran's health system.

Enhancing efficiency is crucial in addressing the escalating scarcity of healthcare resources. It plays a pivotal role in achieving Universal Health Coverage (UHC), with the ultimate goal of ensuring health equity for all. A fundamental strategy to bolster efficiency involves pinpointing the underlying causes of inefficiency within the healthcare system through empirical research. This study aimed to determine and prioritize the causes of inefficiency in Iran's health system. This mixed-method study comprised three phases. The initial phase involved identifying the causes of inefficiency through a comprehensive literature review of relevant studies published between January 1, 2010, to January 1, 2021. The causes were then aligned and prioritized using criteria derived from the literature and expert opinion. Finally, the identified causes were ranked based on their significance using Multiple-Criteria Decision Analysis (MCDA). From an initial pool of 307 causes of inefficiency, they were reduced to 121 causes in the first round of screening which were categorized into 13 thematic topics. The second screening process further narrowed the list to 48 causes. Among these, the leading causes of inefficiency included the inadequate supply and unequal distribution of hospital beds, the overuse of health services, and the mismanagement of the health workforce. In contrast, the use of traditional treatment methods was determined to be the least significant factor contributing to inefficiency. This study identified key inefficiencies in Iran's health system, such as resource misallocation, overuse of services, and workforce mismanagement. Addressing these issues is essential for optimizing resource utilization, enhancing service delivery, and achieving UHC. The findings suggest that policymakers should prioritize reforms in hospital bed distribution, implement strategies to reduce unnecessary health service use, and strengthen human resource management. Additionally, targeted policies that focus on decentralizing healthcare decision-making and enhancing primary care could significantly improve system-wide efficiency. Future research should evaluate the effectiveness of these interventions and explore the role of digital health solutions in mitigating identified inefficiencies.

End-of-Life Health Care Service Use and Cost Among Medicare Decedents With Neurodegenerative Diseases.

Although neurodegenerative diseases are a leading cause of death, little is known about health care utilization and cost during the end-of-life (EoL) period or how it compares with that of other life-limiting conditions. We aimed to describe and compare resource utilization among US Medicare decedents with neurodegenerative diseases with decedents with cancer. We conducted a retrospective study of Medicare Part A and B beneficiaries with Alzheimer disease (AD), Parkinson disease (PD), or amyotrophic lateral sclerosis (ALS) who died in 2018. Decedents diagnosed with malignant brain tumors or pancreatic cancer served as non-neurodegenerative comparators. Descriptive analyses examined demographic and clinical characteristics in the last year of life. The probabilities and associated costs of emergency department (ED), inpatient, skilled nursing facility (SNF), and hospice utilization during the last 12 and 6 months of life were also compared between persons with neurodegenerative diseases and cancer, adjusting for sociodemographic factors and comorbidity burden. A total of 1,126,799 Medicare beneficiaries died in 2018, of which 357,926 had a qualifying diagnosis. Persons with neurodegenerative diseases were older and more frequently received Medicaid assistance than persons with brain or pancreatic cancer. In all groups, health care service utilization increased over the last year of life, and total costs were predominantly attributable to inpatient care. In the last 6 months of life, neurologist care was infrequent among patients with neurodegenerative disease (AD: 1.5%; PD: 8.6%; ALS: 32.0%). Persons with neurodegenerative diseases as compared to persons with malignant brain tumors also had greater odds of ED use (AD: adjusted odds ratio [aOR] 1.17, 95% CI 1.11-1.23; PD: aOR 1.18, 95% CI 1.11-1.25; ALS: aOR 1.11, 95% CI 1.01-1.23), lower odds of hospitalization (AD: aOR 0.64, 95% CI 0.60-0.68; PD: aOR 0.65, 95% CI 0.61-0.69; ALS: aOR 0.33, 95% CI 0.30-0.37), and lower odds of hospice enrollment (AD: aOR 0.33, 95% CI 0.31-0.36; PD: aOR 0.33, 95% CI 0.31-0.36; ALS: aOR 0.41, 95% CI 0.36-0.46). The findings were similar in pancreatic cancer. Persons with neurodegenerative diseases in the United States are more likely to visit the ED and less likely to use inpatient and hospice services at EoL than persons with brain or pancreatic cancer. These group differences may stem from prognostic uncertainty and reflect inadequate EoL care practices, requiring further investigation to ensure more timely palliative care and hospice referrals.

Family caregiving experiences of medical school faculty: high prevalence, high strain, and low resource awareness.

Adult caregiving can be demanding and stressful, especially when the caregiver is employed. As the age of the U.S. population and workforce increases, more adults are providing care to aging family members. To understand the prevalence and aspects of the caregiving experience and caregiving strain among department of medicine faculty members, and to gauge their awareness and utilization of caregiving resources. We used a cross-sectional survey design. A questionnaire survey was developed and launched in Redcap in October, 2022, and an invitation was emailed followed by two reminders to all full-time and part-time faculty members (N = 1053) in our department of medicine. Faculty demographics, caregiver status, caregiving details, degree of mental or emotional strain, and knowledge of and use of employer and external caregiver resources. Of the 1053 faculty members who received up to three email survey invitations, 209 (20%) responded of which 76 (36%) were current caregivers and 117 (56%) were non-caregivers. Among the 76 current caregivers, 53 (70%) reported providing care for parents or parent-in-laws and 9 (12%) reported caring for a spouse. One-third of current caregivers reported caring for individuals with Alzheimer's disease or dementia/memory problems. Ninety-five% of current caregivers reported some or a lot of caregiving strain. A wide variation in knowledge of and use of employer and external caregiver resources was reported. Department of medicine faculty who provide adult caregiving report a high prevalence of strain and wide variation in knowledge of and use of employer and external caregiver support services, suggesting opportunity to better understand where gaps exist in providing support for caregivers.

Developing Transformational Strategies to Improve the Accessibility of E-Governmental Services in South African Local Government

The access to electronic governmental services is an important element of effective governance, particularly in developing nations such as South Africa, where there are still differences in access and skills to digital technologies. As digital transformation becomes increasingly important for effective governance, it is urgently necessary to develop strategies to ensure that all citizens can access electronic governmental services. This study focused on the development of transformation strategies to enhance access to electronic governmental services in local governments in South Africa. This qualitative research used existing literature and case studies to develop transformation strategies to improve access to digital government services. The paper evaluated how the accessibility of electronic government services affected the responsiveness and effectiveness of the provision of local government services. Moreover, the paper also examined the impact of socio-economic factors on the accessibility of electronic services provided by municipalities in South Africa. This included the assessment of the citizens' perceptions of the use and accessibility of the current electronic government services of the municipalities of South Africa. Finally, although electronic public administration services have great potential to enhance local governance in South Africa, their accessibility depends on a solution to socio-economic imbalances, infrastructure limitations, technological obstacles, and trust issues. The study provided strategies for promoting the access of local government e-government services in South Africa. As a result, the findings of the paper contributed to growing knowledge on e-government tactics to improve service delivery and promote good governance practices in South Africa. Keywords: E-Government Services, E-Government, South African Local government, Accessibility

Gynecological health care services utilization and violence among female sex workers in Togo in 2021.

Female Sex Workers (FSW) in Sub Saharan Africa face multiple challenges increasing their vulnerability to poor health, particularly poor sexual and reproductive (SRH) health outcomes and violence. The aim of this study was to assess the use of gynecology health care services and factors associated with its use as well as experiences of violence among FSW in Togo. A cross-sectional study was carried out in 2021 among FSW in two cities of Togo. A snowball sampling method was used and initial seeds were identified in each site in collaboration with FSW non-governmental organizations. A logistic regression was performed to identify factors associated with the use of a SRH service and violence. A total of 447 FSW with a median age of 30 [IQR: (24-38)] participated in this study and 43.4% of them had reached at least secondary school. Among them, 29.1% reported having been to a gynecological consultation over the previous year. Factors associated with a gynecological consultation included: living in the Lomé capital city (aOR = 0.35, 95%CI 0.22-0.54), and an experience of condom breakage or slippage (aOR = 2.00; 95%CI 1.19-2.64). The majority reported at least one lifetime pregnancy (87.9%), 39.8% reported ever having an unintended pregnancy and 67.6% of them ever had an abortion. Finally, 61.1% indicated being victims of physical, sexual, or emotional violence in the previous six months. Sex workers living in Lomé (aOR = 1.78; 95%CI 1.16-2.73); a history of abortion (aOR = 1.53; 95%CI 1.03-2.31) and having more than 15 clients per week (aOR = 4.87; 95% CI 1.99-11.94), were more likely to experience violence. There is an under-utilization of health care services among FSW in Togo in addition to overall poor sexual and reproductive health outcomes with a high prevalence of gender-based violence. Those results highlight the importance of continued advocacy for the integration of SRH care with HIV prevention services geared toward FSW as well as a holistic approach to SRH care with innovative ways to prevent violence.

General practice utilisation by Australian cancer patients in the last year of life.

General practice plays a key role in end-of-life care, yet the extent of this remains largely unknown due to a lack of detailed clinical data. This study aims to describe the care provided by General Practitioners (GPs) for people with cancer in their last year of life. Retrospective cohort study using linked routine primary care and death certificate data in Victoria, Australia. Patients were included who died from cancer between 2008 and 2017. In total 7025 cancer patients were included, mean age of 74.8 yrs. 95% of patients visited their GP in the last 6 months of life, with a median of 11 general practice contacts in this period. 72% of patients visited their GP in the second-last month prior to death, and 74% in the last month of life. The majority of patients (58%) were prescribed opioids, 19% anticipatory medications, 24% received a home visit, and a small proportion had imaging (6%) in the last month and pathology (6%) in the last fortnight. Patients in regional areas had more contact with general practices in the last year of life compared to metropolitan patients (median metropolitan = 16, inner regional = 25, and outer regional = 23, P < .001). The use of GP services did not differ by cancer type. GP's play a central role in end-of-life care provision for cancer patients, which intensifies in the last months of life. There is room for improvement, with a proportion having little or no engagement, and low rates of home visits and anticipatory medication prescribing.

Socioeconomic Inequality in Perceived Need for Mental Healthcare in Patients with Type 2 Diabetes Mellitus in Hamadan, Western Iran

Background and aims: The use of mental healthcare services in type 2 diabetes mellitus (T2DM) patients can depend on socioeconomic status (SES). The current study aimed to evaluate socioeconomic inequality in the perceived need for mental healthcare in patients with T2DM in Hamadan, Western Iran. Methods: This cross-sectional study was conducted between March and July 2023 in Hamadan, Western Iran. The study included T2DM patients who were referred to the Diabetes Center of Hamadan. The variables included in the study were demographics, SES, health insurance status, social support, and self-rated mental health. The outcome of interest was the perceived need for mental healthcare. The socioeconomic inequality was evaluated using concentration index and decomposition analysis. Results: A total of 393 patients (mean age: 56.48±10.65, 62% female and 88% urban inhabitants) were enrolled. The prevalence of perceived need for mental healthcare was 43%, and 50.30% of the patients (85) had delay/avoidance of mental healthcare services. The concentration index (95% confidence interval) of perceived mental healthcare needs was -0.24 (-0.18, -0.30), indicating that perceived needs are more concentrated in the socio-economically disadvantaged patients. Decomposition analysis revealed that low economic status and illiteracy were the main contributors to the inequality (approximately 50%). Cost, minimization, and stigma were the most frequently reported reasons for avoidance/delay of mental healthcare services, respectively. Conclusion: There was a pro-poor socioeconomic inequality in perceived need for mental healthcare among T2DM patients. Healthcare policies and facilities to reduce socioeconomic inequality should mainly focus on disadvantaged T2DM patients.

Clinical Characteristics of Inpatients with Schizophrenia Spectrum Disorder Treated with Electroconvulsive Therapy: A Population-Level Cross-Sectional Study: Titre: Caractéristiques cliniques des patients hospitalisés présentant un trouble du spectre de la schizophrénie et traités par électrochocs : Une étude de population transversale.

Electroconvulsive therapy (ECT) is an evidence-based treatment for schizophrenia when anti-psychotic medications do not sufficiently control symptoms of psychosis or rapid response is required. Little is known about how it is used in routine clinical practice. The aim of this study was to identify the association of demographic and clinical characteristics with administration of ECT for schizophrenia spectrum disorders (SSD). Among psychiatric inpatients with a diagnosis of SSD in Ontario, Canada (2006-2023), patient-level socio-demographic and clinical characteristics were described in those who did and did not receive ECT. We used multi-variable logistic regression to assess the association between patient-level characteristics and administration of ECT during index hospitalization. From 164,632 admissions, 2,168 (1.3%) involved exposure to ≥1 inpatient ECT procedure. Compared to those not receiving ECT, those receiving ECT were older, had higher rates of pre-admission medication use, medical and psychiatric comorbidities, outpatient mental health service use, but lower rates of substance use disorders. In the multi-variable logistic regression model, patient-level characteristics most strongly associated with receiving inpatient ECT were the presence of catatonia (odds ratio [OR]: 5.83; 95% confidence interval [95% CI]: 4.01-8.46), comorbid depression (OR: 2.49; 95% CI: 2.07-2.98), obsessive-compulsive disorder (OR: 2.16; 95% CI: 1.55-3.00), while characteristics most strongly associated with not receiving inpatient ECT were myocardial infarction (OR: 0.44; 95% CI: 0.20-0.95) and family conflict towards patient (OR: 0.47; 95% CI: 0.31-0.71). Neither severity of psychotic symptoms, non-command auditory hallucinations nor delusions were associated with administration of ECT. While characteristics associated with the use of ECT are generally consistent with the indications for ECT (e.g., catatonia, mood disorders), ECT is rarely used amongst individuals with SSD. Severity of psychotic symptoms was not associated with the use of inpatient ECT suggesting an opportunity to increase the use of ECT in this population.

QOL-04. THE UNDER-UTILIZATION OF PALLIATIVE CARE SERVICES BY PATIENTS WITH GLIOBLASTOMA HIGHLIGHTS THE IMPORTANCE OF DISCUSSIONS AROUND PALLIATIVE CARE: A CROSS-SECTIONAL STUDY WITH CARE PARTNERS OF PATIENTS WITH GBM RECRUITED FROM FACEBOOK SUPPORT GROUPS

Abstract Glioblastoma (GBM) is a terminal brain cancer that has a rapid onset and results in symptoms such as headaches, vomiting, seizures, anxiety, depression, agitation, speech impairment, memory impairment, infections, brain bleeds, mobility changes, changes in sleep patterns, and cognitive changes. Palliative care helps patients diagnosed with an incurable or chronic disease manage physical, social, and psychological symptoms and has been shown to increase survival for patients with cancer. Previous data of former care partners of patients with GBM indicated only 30% of patients used palliative care whereas 90% used hospice. To better understand the reasons for underutilization of palliative care patients with GBM, 38-question survey about the use of palliative care, type of medical center where treatment occurred, and discussions with care team members about palliative care was given to current care partners recruited from Facebook support groups in February 2024. Inclusion criteria: current primary care partner of a patient with GBM, over the age of 18, and willing to participate (IRB exempt; H24-0393). The care partner was excluded if their patient was no longer living. Of the 77 current care partners, 56 reported they did not use palliative care as part of their care team. The use of palliative care was similar among care facilities (community hospital, major medical center, university hospital, brain tumor center). When care team members discussed palliative care with patients and their care partners (n=21), 71% of the dyads used palliative care. When care team members did not discuss palliative care (n=56), the use of palliative care was much lower at 7%. Interestingly, 55% of respondents reported they would benefit from knowing more about ways to increase physical and emotional support. This data suggests discussions around palliative care increase the use of palliative care services among patients with GBM and their care partners.

Aging in place or aging out of place? Family caregivers' perspectives on care for older Pakistani migrants in Norway.

The aging population in Europe is increasing, with growing ethnic diversity among older individuals due to migration. Public policies emphasize 'aging in place' to address financial challenges and reduce the burden on the healthcare system. However, research often overlooks the heterogeneity among older people, especially non-European migrants. Also, research on family caregivers' role in enabling 'aging in place' for older relatives with migrant backgrounds is limited, despite many older non-European migrants' preference for family care in comparison to long-term institutional care. This study aims to explore the experiences and perspectives of family caregivers in the context of formal and informal care and their preferences regarding the place of care for older family members with migrant backgrounds, particularly the Pakistani Ahmadiyya community in Norway. Eighteen semi-structured individual interviews and two group interviews were conducted in Urdu and English with nineteen female family caregivers of older relatives, ages 25-62, residing in Norway. The analysis yielded three main themes: (1) "Nursing homes are not for the ones who love their parents", (2) Preferences for home with the possibility of sharing care, and (3) Mismatch between family care needs and formal care. Family caregivers' perception of health services has a decisive impact on their older relatives' demand and use of formal health services, emphasizing the need for trust. Even though home care services were seen as a viable option, they should be adapted so that the family caregivers can use them and feel supported in enabling 'aging in place' for older migrants.

Stochastic Frontier Analysis of Technical Efficiency of Smallholder Maize Farmers in Morogoro Municipality: A Reflection from RIPAT Program

This study looks into the elements that influence maize production and technical efficiency among households participating in the RIPAT SUA Project in Morogoro Municipality, using stochastic frontier analysis for the 2022 – 2023 season. The focus was on socio-economic characteristics, land size, seed usage, use of fertilizer extension services, training from the project, and education. The primary objective was to examine the factors influencing maize production and efficiency by evaluating socioeconomic aspects and specific agricultural techniques. A total of 110 households were surveyed with standardized questionnaires. Socioeconomic data was collected, key variables were evaluated and key variables were analyzed using descriptive statistics and stochastic frontier analysis. The results reveal that land size harms productivity (β = -0.436, p &lt; 0.001), whereas improved seed usage has a positive impact (β = 0.401, p = 0.016). Education level (β = -1.168, p = 0.002) and agriculture experience (β = -0.016, p = 0.049) considerably reduce technical inefficiency, insisting on the importance of education interventions. Additionally, 40% of households have access to VSLA, revealing financial problems. While 94.55% of households got training, only 18.18% received extension services which could hamper the best productivity. Every household reported owning land and using seeds highlighting that they had the necessary materials for maize production. Regarding technical efficiency, Magadu ward high score of 5%, while Kauzeni has the lowest at 1.9% suggesting significant disproportions in productivity among wards. These findings emphasize the importance of focused initiatives to improve agriculture productivity through enhancing farmer education and training, experience, and increased access to finance. These strategies are critical for improving maize productivity and addressing food security issues among households participating in programs like the RIPAT SUA initiative hence will increase agricultural efficiency and contribute to more farmer-sustainable farming methods throughout the region