Illness Services Research Articles

Determinants of Long COVID illness duration and service use-an Irish retrospective cohort study

Abstract The Follow-up After Disease Acquisition (FADA) study is a retrospective cohort study of COVID-19 recovery, aimed to characterise the nature and severity of Long COVID (LC) in an Irish community-based sample. Duration analysis is conducted applying Cox’s proportional hazards model to those self-reported recovered from LC (n = 577) and a Gompertz distribution parametric model, determined best fit by AIC, for those still ill with LC (n = 928) at time of survey completion. A negative binomial model is estimated to understand the variation of services accessed for LC. The Hazard in this instance is recovery(<1 = contributing factor to duration). Factors significantly contributing to duration of illness are never married (Hazard Ratio (HR):0.689;p:0.01) higher physical activity levels prior to first C-19 infection (HR:0.964; p:0.06) and number of COVID-19 infections (H:0.926;p:0.07). Those that contract more recent variants are likely to recover quicker from their LC illness (baseline Wildtype. Alpha HR:1.7;p:0.0; Delta HR:3.36;p:0.0; Omicron HR:3.8; p:0.0). In variation of services used for LC, there are some major differences between those self-reporting as recovered from LC at time of survey completion and those still ill. Of those recovered, men, those sickest with LC and sick longest use a wider variation of services. Single people use a significantly narrower range of health services to combat their illness. For those still ill higher education, higher levels of physical activity pre COVID-19, healthcare workers, higher rates of comorbidity, those sick longest and those whose health has been most impacted by LC use a wider variation of services. A poorer health rating negatively impacts variation of services accessed for LC illness. More recent strains of COVID-19 are significantly less likely to lead to LC, this offers hope for the future, albeit more research is required to investigate factors to improve recovery rates for those already experiencing LC. Key messages • Those with Long COVID that recover quickly are fundamentally different to those that do not. • The number of COVID-19 infections is a key indicator of length of Long COVID illness, we need to protect our most vulnerable and put appropriate safeguards in place for healthcare provision.

Changes in primary care visits for respiratory illness during the COVID-19 pandemic: a multinational study by the International Consortium of Primary Care Big Data Researchers (INTRePID).

The majority of patients with respiratory illness are seen in primary care settings. Given COVID-19 is predominantly a respiratory illness, the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID), assessed the pandemic impact on primary care visits for respiratory illnesses. Definitions for respiratory illness types were agreed on collectively. Monthly visit counts with diagnosis were shared centrally for analysis. Primary care settings in Argentina, Australia, Canada, China, Norway, Peru, Singapore, Sweden and the United States. Over 38 million patients seen in primary care settings in INTRePID countries before and during the pandemic, from January 1st, 2018, to December 31st, 2021. Relative change in the monthly mean number of visits before and after the onset of the pandemic for acute infectious respiratory disease visits including influenza, upper and lower respiratory tract infections and chronic respiratory disease visits including asthma, chronic obstructive pulmonary disease, respiratory allergies, and other respiratory diseases. INTRePID countries reported a marked decrease in the average monthly visits for respiratory illness. Changes in visits varied from -10.9% [95% confidence interval (CI): -33.1 to +11.3%] in Norway to -79.9% (95% CI: -86.4% to -73.4%) in China for acute infectious respiratory disease visits and - 2.1% (95% CI: -12.1 to +7.8%) in Peru to -59.9% (95% CI: -68.6% to -51.3%) in China for chronic respiratory illness visits. While seasonal variation in allergic respiratory illness continued during the pandemic, there was essentially no spike in influenza illness during the first 2 years of the pandemic. The COVID-19 pandemic had a major impact on primary care visits for respiratory presentations. Primary care continued to provide services for respiratory illness, although there was a decrease in infectious illness during the COVID pandemic. Understanding the role of primary care may provide valuable information for COVID-19 recovery efforts and planning for future global emergencies.

Practical challenges for mental health services among Rohingya refugee in Bangladesh

Rohingya Muslims have been forcefully displaced from their mother land, Rakhaine State, Myanmar to Bangladesh, a country with about 170 million population with a treatment gap of more than 90% for standard mental health care. Due to the experienced trauma and displacement, high prevalence of depression, anxiety and post-traumatic tress disorders has been identified among Rohingya refugees in addition to the enduring mental health burden of Bangladesh. Very little has been known regarding the practical challenges of mental health services among Rohingya refugees in Bangladesh. In this commentary, we aimed to highlight the practical challenges for mental health services in Rohingya camps in Bangladesh along with our speculative ways forward based on available evidence, work experience, and informal communications. We highlighted the available mental health services, several major challenges including awareness, perception and belief towards mental health, language and cultural barriers, dearth of skilled service providers, inadequate services for severe mental illness, dearth of mental health services for children, inadequate provision of supervision and ‘Care for Caregivers’ program, and privacy and confidentiality of the clients. Although significant improvements have been made in the mental health field in the emergency crisis sector in Cox's Bazar over the past years, concentrated efforts are urgently required to actualize proposed solutions in this paper.

Helen Salisbury: Sick notes and a national illness service.

Helen Salisbury: Sick notes and a national illness service.

Integrating smartwatches in community mental health services for severe mental illness for detecting relapse and informing future intervention: A case series.

This case series explored the integration of smartwatches in a community mental health service to support severe mental illness (SMI) management and intervention. We examined whether biometric data provided by smartwatches could help to predict relapse and inform treatment decisions. Four Australian SMI outpatients of mixed diagnoses (age range = 19-24) were selected from a prior study. Clinicians accessed patients' biometric data (activity, sleep, heart rate, and electrodermal activity) through smartwatches. Changes in circadian rhythm and electrodermal activity preceded hospitalization in two cases. Additionally, smartwatch data was effectively used to guide targeted interventions, improving patient treatment outcomes. Integrating smartwatches in community mental health services offers promise as adjunct tools for SMI management. However, ethical considerations on data privacy and technology reliance require further evaluation. Additionally, as this is a small case series, randomized controlled trials with larger sample sizes are required to provide evidence for generalisability of results.

Workforce strategies to address children's mental health and behavioural needs in rural, regional and remote areas: A scoping review.

Children living in rural, regional and remote locations experience challenges to receiving services for mental illness and challenging behaviours. Additionally, there is a lack of clarity about the workforce characteristics to address the needs of this population. To scope the literature on the rural, regional and remote child mental health and behavioural workforce and identify barriers and enabling mechanisms to mental health service provision. A scoping review utilising the Joanna Briggs Institute methodology. A database search was undertaken using Medline, CINAHL, PsycINFO, ProQuest and Scopus to identify papers published 2010-2023. Research articles reporting data on mental health workforce characteristics for children aged under 12 years, in rural, regional or remote locations were reviewed for inclusion. Seven hundred and fifty-four papers were imported into Covidence with 22 studies being retained. Retained studies confirmed that providing services to meet the needs of children's mental health is an international challenge. The thematic analysis of the review findings highlighted four workforce strategies to potentially mitigate some of these challenges. These were: (1) The use of telehealth for clinical services and workforce upskilling; (2) Role shifting where non mental health professionals assumed mental health workforce roles; (3) Service structure strategies, and (4) Indigenous and rural cultural factors. A range of potential strategies exists to better meet the needs of children with mental health and behavioural issues. Adapting these to specific community contexts through co-design and production may enhance their efficacy.

Screening for those at risk for anxiety and depression warranting further clinical evaluation among patients presenting to breast services: a single-centre, cross-sectional study

ObjectivesStudies show that anxiety and depression are widespread across patients presenting to outpatient services for medical illnesses. We expect similar or even higher prevalence in patients with breast complaints owing...

HEALTH SERVICES FOR PEOPLE WITH MENTAL DISORDERS DURING THE COVID-19 PANDEMIC: A SCOPING REVIEW

The global COVID-19 pandemic has significantly disrupted healthcare delivery, with mental health services facing the compulsion to innovate rapidly. This scoping review aims to systematically gather literature-based evidence that can guide governments and healthcare providers in their response to the mental health needs arising during the pandemic. Using a scoping review methodology, this study aggregates and examines data on mental health services for individuals with mental disorders amid the COVID-19 crisis. A strategic search across electronic databases such as ScienceDirect, Ebscohost, and Google Scholar utilized key terms "People with Mental Illness AND Health Service AND Pandemic COVID-19," in addition to Indonesian equivalents, to ensure a comprehensive collection of relevant articles. Selection criteria were strict, focusing on primary research, English-language, full-text articles published within the years 2020 to 2021. Upon analyzing six pertinent journal articles, it was determined that there has been a notable shift towards the utilization of online platforms for delivering mental health services during the pandemic, complementing the persisting, albeit limited, offline, in-person services conducted under stringent health safety protocols. This adaptation reflects the resilience of the mental health sector in maintaining service delivery amidst the constraints imposed by the ongoing health emergency.

Health practices, behaviours and quality of life of low-income preschoolers: A community-based cross-sectional comparison study in Singapore

Introduction: Children from low-income (LI) families often suffer from poor health, with sub-optimal health practices. This cross-sectional study examined the differences in health habits and health-related quality of life (HRQoL) of LI preschool children compared to non-low-income preschool peers (PPG). Method: Using data from the social-health Circle of Care-Health Development Screening Programme (CoC-HDSP) in Singapore, 118 LI children and 304 PPG children aged 18 months to 6 years old and their families were recruited from 13 government-funded preschools. Health practices examined included screen time habits, sleep, nutrition, dental health and the children’s HRQoL using PedsQL 4.0 Generic Core Scales. Results: Majority of the children were aged 4–6 years in kindergarten 1 and 2. There were more Malay children in the LI than the PPG (61.9% versus [vs] 29.3%, P<0.001). Low-income children were more likely to have lower-educated parents (P<0.001). The completed vaccination rate in the LI group was lower than those in PPG (84.7% vs 98.0%, P<0.001). More in the LI group utilised emergency services for acute illnesses (P<0.05). Fewer LI children had ever visited a dentist (47.4% vs 75.4%, P<0.001), and more LI children consumed sweetened drinks daily (33.3% vs 8.6%, P<0.001). The LI group reported poorer-quality sleep (48.3% vs 27.2%, P<0.001), though both groups exceeded the daily recommended screen viewing duration. The LI group scored higher in the social (mean 92.4+12.2 vs 84.3+15.3, P<0.001) and emotional (mean 85.2+15.1 vs 76.6+17.3, P<0.001) domains of the PedsQL 4.0 when compared to PPG. Conclusion: Low-income children have poorer health practices, receive less preventive paediatric care, and utilise more emergency services for acute illnesses. These findings are important for developing interventions that work towards improving the health of LI children.

Health practices, behaviours and quality of life of low-income preschoolers: A community-based cross-sectional comparison study in Singapore.

Children from low-income (LI) families often suffer from poor health, with sub-optimal health practices. This cross-sectional study examined the differences in health habits and health-related quality of life (HRQoL) of LI preschool children compared to non-low-income preschool peers (PPG). Using data from the social-health Circle of Care-Health Development Screening Programme (CoC-HDSP) in Singapore, 118 LI children and 304 PPG children aged 18 months to 6 years old and their families were recruited from 13 government-funded preschools. Health practices examined included screen time habits, sleep, nutrition, dental health and the children's HRQoL using PedsQL 4.0 Generic Core Scales. Majority of the children were aged 4-6 years in kindergarten 1 and 2. There were more Malay children in the LI than the PPG (61.9% versus [vs] 29.3%, P<0.001). Low-income children were more likely to have lower-educated parents (P<0.001). The completed vaccination rate in the LI group was lower than those in PPG (84.7% vs 98.0%, P<0.001). More in the LI group utilised emergency services for acute illnesses (P<0.05). Fewer LI children had ever visited a dentist (47.4% vs 75.4%, P<0.001), and more LI children consumed sweetened drinks daily (33.3% vs 8.6%, P<0.001). The LI group reported poorer-quality sleep (48.3% vs 27.2%, P<0.001), though both groups exceeded the daily recommended screen viewing duration. The LI group scored higher in the social (mean 92.4±12.2 vs 84.3±15.3, P<0.001) and emotional (mean 85.2±15.1 vs 76.6±17.3, P<0.001) domains of the PedsQL 4.0 when compared to PPG. Low-income children have poorer health practices, receive less preventive paediatric care, and utilise more emergency services for acute illnesses. These findings are important for developing interventions that work towards improving the health of LI children.

The Use of Mobile Medical Units for Populations Experiencing Homelessness in the United States: A Scoping Review.

With annual point-in-time counts indicating a rise in unsheltered homelessness in the United States, much attention has been paid to how to best provide care to this population. Mobile medical units (MMUs) have been utilized by many programs. However, little is known regarding the evidence behind their effectiveness. A scoping review is conducted of research on MMU provision of medical services for populations experiencing homelessness in the USA to examine the extent and nature of research activity, summarize available evidence, and identify research gaps in the existing literature. Following guidelines for scoping reviews, PubMed and Google Scholar were used to identify an initial 294 papers published from January 1, 1980, to May 1, 2023, using selected keywords, which were distilled to a final set of 50 studies that met eligibility criteria. Eligible articles were defined as those that pertain to the provision of healthcare (inclusive of dental, vision, and specialty services) to populations experiencing homelessness through a MMU in the United States and have been published after peer review. Of the 50 studies in the review, the majority utilized descriptive (40%) or observational methods (36%), with 4 review and 8 controlled studies and no completed randomized controlled trials. Outcome measures utilized by studies include MMU services provided (58%), patient demographics (34%), health outcomes (16%), patient-centered measures (14%), healthcare utilization (10%) and cost analysis (6%). The studies that exist suggest MMUs can facilitate effective treatment of substance use disorders, provision of primary care, and services for severe mental illness among people experiencing homelessness. MMUs have potential to provide community-based healthcare services in settings where homeless populations reside, but the paucity of randomized controlled trials indicates further research is needed to understand if MMUs are more effective than other care delivery models tailored to populations experiencing homelessness.

Integrated management of childhood illness in Rwanda: Impact of mentorship on the quality of care in Nyanza and Huye districts

AbstractBackgroundIn Rwanda, health posts (HPs) are intermediary primary care facilities that provide comprehensive primary care services to communities and are located at a reasonable walking distance from people's homes. We assessed the readiness of HPs for Integrated Management of Childhood Illness (IMCI) services and examined changes in the quality of care for IMCI services between districts that implemented IMCI mentorship program (Nyanza district) and Huye district which it did not.MethodsWe conducted a prospective cohort study to assess whether there was change in the quality of IMCI care provided at 17 Nyanza HPs 1‐year after IMCI mentorship implementation. The readiness of HPs for IMCI was assessed across nine factors, resulting in essential (all factors) and desirable (less than seven factors) composite scores. Unpaired t‐tests were used to measure changes in IMCI quality.ResultsThe HPs with IMCI mentorship had an increase in mean desirable (0.7–0.89) and essential (0.61–0.78) composite scores compared to non‐mentored HPs in Huye. The nurses who received mentorship program had improved scores in factors like IMCI training, service package availability, register availability, supportive supervision, and basic equipment availability. Quality improvements in IMCI assessments were observed in vital sign registration, danger sign detection, cough identification, malnutrition screening, and tuberculosis sign identification in the mentored HPs.ConclusionMentorship of nurses in HPs holds promise for enhancing facility readiness and IMCI service quality. Before expanding clinical mentorship, identified gaps such as staffing, supply chains, and health financing need to be addressed.

Applying the Visual-Verbal Video Analysis Framework to Understand How Mental Illness is Represented in the TV Show Euphoria

Mental illness in media can shape viewer’s beliefs about mental health, help-seeking, and empathic behaviors. The current study sought to investigate how mental health and substance use is depicted in popular media targeted for youth. The visual-verbal video analysis (VVVA) framework was applied to the HBO American drama television series Euphoria to understand how mental illness, substance use, and mental health service use is portrayed, and how characters respond to mental health scenes. Euphoria follows a group of high school students as they navigate adolescence, mental illness and substance use. The VVVA provides a framework for social science and medical researchers to qualitatively analyze multimodal information (e.g., text, cinematography, music and sounds, body language and facial expressions) of visual content. This commentary will briefly describe the VVVA framework, provide an overview of how the framework was applied and adapted to analyze a scene in the television series Euphoria, note similarities and differences to the original VVVA framework, and benefits and drawbacks. The VVVA framework was flexible and effective in coding various elements (e.g., body language, camera angles) in a scene in Euphoria.

Outpatient Navigation Increases Enrollment In Serious Illness Services For Outpatients With Chronic Heart Failure

Outpatient Navigation Increases Enrollment In Serious Illness Services For Outpatients With Chronic Heart Failure

“Healing is having faith in Allah, the healer, and the medicine": An exploratory qualitative study of Islamic-based healing practices in Northern Ghana

Faith-based healing practices are becoming widespread in Ghana. Charismatic churches, traditional healers, and Islamic faith healers provide healthcare services for multitudes nationwide. However, Islamic faith-based healers' medical perspectives and healing practices are less known. This descriptive exploratory qualitative study explores Islamic-based healing practices among the Dagomba and how Dagbon culture influences Islamic-based healing. Data were collected from six Islamic-based healers through participant observations and in-depth individual interviews using a semi-structured interview guide. Thematic analysis was employed, and results are reported narratively. The study discovered that Islamic-based healing is important in Dagbon, with healers providing healing services for diverse illnesses. Practitioners of Islamic-based healing among the Dagomba observe that having faith in Allah and trust in His healing powers is the foundation of health. Islamic principles of faith and the Dagomba worldviews of health and illness affect these healers’ medical knowledge and healing practices. The study found that rituals and sacrifices are significant healing practices with unique gendered perspectives. Spirituality is perceived as both an illness-causal factor and a healing tool. We invite further research to identify the prospects, constraints, and therapeutic possibilities Islamic medicine and healing hold for Ghana’s integrative medical system_._

Sitting Ducks Post-COVID? Work Organisation and Compounded Health Risks for Darjeeling Tea Workers

This article argues that burgeoning economic uncertainty, competitiveness of commodity production after COVID-19 and labour reforms may facilitate the industry to reorganise work arrangements through labour flexibilisation and mechanisation, accentuate health precarity, and nefariously push the disenfranchised Darjeeling tea labour further into oblivion. Workers’ access to basic healthcare services for illnesses and diseases such as fevers, diarrhoea, dysentery, anaemia, and hypertension pivots on the fragile lines of power and ethno-gender that are deeply embedded in plantation societies. Subsequently, social distancing as a preventive everyday measure during the pandemic appears to have reinforced both class and caste divide among these communities. The tangible absence of a robust health infrastructure in the Darjeeling hills exposes the undeniable shift in the responsibility of healthcare by the tea garden management on workers’ households and the samaj, as a social collective in managing illness and care.

Use of co-production to explore food insecurity in adults with severe mental illness living in Northern England: a mixed-methods study

BackgroundPeople living with severe mental illness experience premature mortality from diet-related preventable illnesses. Yet, little research focuses on food insecurity with adults with severe mental illness. This coproduced study aimed to understand the experiences of adults with severe mental illness and food insecurity and strategies to help. MethodsFollowing a pragmatism philosophical foundation, we undertook a mixed-methods study involving a survey (online and paper versions) and one-to-one semi-structured interviews (online and telephone) during March 7 to Dec 16, 2022. We recruited participants via existing severe mental illness service user groups and social media in Northern England. Eligible participants were adults (≥18 years) self-reporting a diagnosis of severe mental illness. Ethics approval was obtained from Teesside University and the Health Research Authority (Reference: 22/NR/0010; IRAS ID: 306281), with informed consent given. The target sample size, accounting for a typical survey response rate for people with severe mental illness of 10–20%, was 135. A target sample of 20 interviews was agreed to capture a range of views. Food insecurity was defined as the lack of financial resources needed to ensure someone has reliable access to enough food to meet their dietary, nutritional, and social needs. It is sometimes called food poverty. Quantitative data were analysed using descriptive statistics and binary logistic regression and qualitative data using thematic analysis. Findings135 participants completed the survey (mean age 44·67 years [SD 14·1]). Participants were predominantly male (53%, n=72), white (87%, n=117), and from the Yorkshire region (50%, n=68). Overall, prevalence of food insecurity was 50·4% (n=68). Discussion across 13 interviews found food insecurity being a long-rooted experience, including familial and intergenerational experiences of food insecurity: “I grew up… with this insecurity around food” (P002). Recommendations for tackling food insecurity centred on food banks, increasing accessibility, and reducing stigma: “I would like to get more information on where the centres are...” (P006) and “I was referred to, erm, a foodbank … but it's still the stigma that's attached to it.” (P002). InterpretationWe found a higher prevalence of food insecurity in this study than in the general population (being 15%), yet limited research with adults with severe mental illness perpetuates food insecurity intergenerational injustices. Food insecurity should be eliminated. However, in the meanwhile, there should be widespread easy access to food banks offering nutritional foods. Limitations of this research include not reaching target sample size and a lack of ethnic diversity. FundingNational Institute of Health and Care Research (NIHR) Research for Patient Benefit.

Poverty alleviation and health services for the poor in China: evidence from national health service surveys in 2013 and 2018

BackgroundChina has made intensive efforts to eliminate extreme poverty by 2020. This paper aims to evaluate the changes in health service needs, utilization, and medical expenses for poor people during the poverty alleviation period.MethodsThe study used data from national health services surveys in 2013 and 2018. The poor people were identified and certified by the local government. Health service needs, utilization, medical expenses, and reimbursement rates were analyzed and compared between 2013 and 2018, between the poor and the non-poor groups.ResultsPeople living in poverty were usually elderly, illiterate, and unemployed. The poor people had a significantly higher two-week morbidity rate and a higher prevalence of chorionic non-communicable diseases than the non-poor group. For both the poor and non-poor, health service needs increased between 2013 and 2018. Accordingly, the poor people had more use of outpatient and inpatient services. The annual inpatient admission rates were 20.8% and 13.1% for the poor and non-poor, respectively, in 2018. The average medical expenses per inpatient admission were much lower for the poor than for the non-poor. Out-of-pocket (OOP) payment share decreased from 41.9% to 2013 to 31.9% in 2018 for the poor, while for the non-poor, the OOP rate was much higher (45.4%) and had no significant changes between the two surveys. The reduction in the OOP share occurred mostly in rural areas.ConclusionsPoverty alleviation in China may have positive effect in improving poor people’s access to health services, and reducing their financial burden due to illness and health service utilization.

SAMHSA awards $131.7 million to support at‐risk youth

Last week the Substance Abuse and Mental Health Services Administration (SAMHSA) announced $131.7 million awarded this month in grant programs that connect youth and families to services for substance use disorder and mental illness.

Numeracy and literacy attainment of children exposed to maternal incarceration and other adversities: A linked data study

Parental incarceration has been associated with educational disadvantages for children, such as lower educational attainment, increased grade retention, and truancy and suspensions. However, children exposed to parental incarceration often experience other adversities that are also associated with educational disadvantage; the contribution of these co-occurring adversities has not been considered in previous research. This study aimed to investigate the educational outcomes of children exposed to (a) maternal incarceration alone and (b) maternal incarceration plus other adversities (i.e., maternal mental illness and/or child protective services [CPS] contact). We used linked administrative data for a sample of children whose mothers were incarcerated during the children's childhood (i.e., from the time of mother's pregnancy through the child's 18th birthday; n = 3828) and a comparison group of children whose mothers had not been incarcerated (n = 9570). Multivariate multinomial logistic regressions examined the association between exposure to the three adversities (i.e., maternal incarceration, maternal mental illness, and child CPS contact) and above or below average reading and numeracy attainment in Grades 3, 5, 7 and 9. At all grade levels, children exposed to maternal incarceration alone and those exposed to maternal incarceration plus other adversities had increased odds of below average numeracy and reading attainment and decreased odds of above average numeracy and reading attainment compared to children without any of the recorded exposures. Children exposed to maternal incarceration and CPS contact and those exposed to all three adversities had increased odds of below average reading and numeracy attainment compared to children exposed to maternal incarceration alone. The findings highlight the complex needs of children of incarcerated mothers that must be considered when designing and delivering educational support programs. These children would benefit from the implementation of multi-tiered, trauma-informed educational and clinical services.