Seeking Health Care Services Research Articles

Multidrug resistant Escherichia coli among patients with gastrointestinal tract infections seeking health care services at Lafia, Nigeria

Gastrointestinal tract (GIT) in human plays an important role in providing habitat to various microbial communities including numerous prokaryotic cells numbering over 100 trillion. This study was aimed at accessing the multidrug resistance (MDR) of E. coli among patients with GIT infections seeking health care at Dalhatu Araf Specialist Hospital (DASH), Lafia, Nasarawa state, Nigeria. A total of one hundred and fifty (150) stool samples were collected using sterile sample containers from patients with symptoms of GIT infections in search of medical care in this hospital. The samples collected were processed using standard microbiological methods. Out of the total samples collected, 35.3% (53/150) revealed the presence of E. coli whereas 64.7% did not. Extended spectrum beta-lactamases (ESBL) were found in 45.3% of E. coli obtained in this study, which were further used for the antimicrobial susceptibility test. E. coli were more resistant to ampicillin (75.51%), followed by amoxycillin/clavulanic acid (61.22%) and were least resistant to imipenems (12.25%). In conclusion, MDR E. coli producing ESBL are abundant among patients with GIT infections visiting DASH, Lafia. Thus, it is important to determine the genes responsible for this MDR as well as dissemination of adequate information to the masses visiting the hospital for treatment on the possible effects caused by the antibiotics abuse
 Keywords: Escherichia coli, Multiple-Drug Resistance, Antimicrobial, Gastrointestinal tract, Extended Spectrum Beta-Lactamases, Microbiological methods

User perspectives and preferences regarding a mobile health cough application: A qualitative study during the coronavirus disease pandemic in Denmark.

IntroductionHealth care systems worldwide are currently facing major challenges because of the coronavirus disease pandemic. When individuals experience coronavirus disease symptoms, they often have to decide whether to seek health care services and render themselves vulnerable to infection or stay home and monitor their condition. Coronavirus disease management strategies should aim to reduce transmission, promote disease control, and facilitate self-monitoring within the population. In this regard, mobile health technologies serve as supportive tools, and acquiring knowledge about user perspectives will facilitate the development and integration of coronavirus disease-related applications. Accordingly, this study aimed to examine user perspectives on applications that monitor coronavirus disease-related physical signs and identify discrepancies between user expectations and developer design perspectives within the Danish context.Materials and methodsA qualitative research design was adopted. Semi-structured telephone interviews were conducted to examine user expectations during the first wave of the coronavirus disease pandemic in April 2020. The theoretical framework, which was inspired by the concept of health literacy, was developed using a six-step thematic analytic approach.ResultsThe analysis yielded two major themes that captured user experiences: (1) coronavirus disease-related applications may serve as digital tools that foster safety when physical signs are monitored and (2) the acceptability of coronavirus disease-related applications depends on the adoption of a personalised and user-friendly design.

Factors shaping decisions to utilize maternal health services among the urban poor of south Delhi: A longitudinal case study

Ending preventable maternal mortality remains one of the most critical challenges despite significant progress over past decades. Maternal mortality remains high and the burden of death is disproportionately higher among the marginalized population. Contrary to the view that those residing in urban areas have better access to quality health services, the health outcomes of the urban poor are not better than rural communities. Data on urban poor are concealed within urban averages, and few studies provide disaggregated data on spatial dimensions of population in urban areas. The study was conducted to understand variations and factors responsible for decisions to seek healthcare services for maternal healthcare. The study was conducted using qualitative case study design and qualitative data were collected from fifty pregnant women enrolled from two slums of south Delhi after informed consent. The slums were revisited twice after a gap of two/three years to understand changes in maternal health seeking behaviour of the communities. Data were analyzed using grounded theory methodology. The maternal health seeking behaviour among urban poor is determined by structural inequalities, predisposing factors of individuals including age, income, education, and parity. Other factors that had a bearing on their decision to seek care included legal status of the slums, and its inhabitants. Incremental changes in health seeking behaviour overtime was observed due to government policies/programs implemented to benefit the poor. It is essential to build a sensitive and responsive health system that is acceptable to the most marginalized to enhance access to health services.Understanding factors contributing to urban poor seek maternal health care services is necessary to build a sensitive and responsible heath system that is acceptable to the most marginalized and will ensure its use.

Factors Influencing Client's Decision-Making Process In Private Health Care Institutions In Nigeria

The impact of the health care sector and economic vitality plays a major role in the upliftment of the welfare of the society. A country's stability and sustainability will depend on how healthy its population is (Patry, Morris & Leatherman, 2010). Therefore, the reduction in mortality rate and an increase in healthy work force that performs work duties are likely to promote economic activities which will in turn increase the country's wealth. Clients seek health care services that can improve the state of their well-being. Since health care services are needed to promote well-being, clients are particular about how and where they purchase health care services from (Akponah, Mazibuko & Krüger, 2015:153). Numerous researchers have studied the factors that determine clients' decision-making in the utilization of health care services. Andersen and Newman (2005:14) put forward that predisposing, enabling and illness level influence the clients' decision to utilize health care services. Mekonnen and Mekonnen (2002:2) report that gender as a demographic factor influences the decision-making of clients regarding the utilization of health care services. However, Williams (2005:35) maintains that client attitudes regarding their decisions to utilize and access health care services from private health care institutions are influenced by their social structure, occupation, education, ethnicity, cultural, attitudes and beliefs relating to values, knowledge and attitudes from past experience. This study investigates and answers the following questions: What factors influences clients' decision-making regarding the utilization of private health care institutions? Keywords: Health care services; decision-making process; health care institutions; health insurance; clients.

LGBT individuals' opinions about their health care experiences: A qualitative research study.

To determine the health problems of LGBT individuals and the conditions of their utilization of health care services from their own perspectives. Although the health care services have improved over the last decades, LGBT individual still face unique challenges when seeking health care services. This study was performed using the phenomenological technique as a qualitative research method. The sample consisted of 18 LGBT individuals selected using purposive sampling. Data were collected by semi-structured interviews using focus group and analysed using content analysis. Two main themes emerged as a result of the content analysis: awareness and status of benefiting from health care. To obtain quality care for LGBT individuals, the health care professionals need a persistent awareness-specific knowledge of LGBT health issues. The findings of this study can be a warning for managers and policymakers to plan seriously to reform health care services infrastructures. Content about the health needs of LGBT individuals can be added to the curriculum of medical and nursing schools.

HEALTH LITERACY AND HEALTH CARE SEEKING BEHAVIOR OF THE ELDERLY IN HUE CITY

Objectives: To assess the health literacy and identify the relationship between the health literacy and health care seeking behavior among the older persons in Hue city. Methods: A cross-sectional study was conducted in Hue city. 400 older persons were interviewed directly using a structured questionnaire. Health literacy was assessed by HLS- Asian- Q. Multivariate logistic regression model was used to identify the relationship between health literacy and health care seeking behavior. Results: 20.0% of the respondents got inadequate health literacy. The proportion of the elderly who achieved health literacy in health care, health prevention and health promotion were 25.7%, 10.0% and 28.0%, respectively. The percentage of the elderly who have sought health care services and health promotion services were 76.7% and 68,0%, respectively. There was a relationship between health literacy and treatment seeking behaviour (OR= 3.71; 95% CI: 1.25-11.01) and health prevention service seeking behaviour among participants (OR=3.30; 95% CI:1.16-9.40). Conclusions: Health literacy of the elderly was still low in Hue city. There is influence of health literacy on health care seeking behavior among them. Enhancing health literacy for the older persons should be a necessary solution to improve their health status. Keywords: Health literacy, health seeking behavior, older persons, Hue city.

“Coming out” against cancer: How local outreach to the LGBT community can reduce cancer disparities.

131 Background: Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals make up an estimated 4% of the population, qualifying them as a sexual minority. LGBT individuals are also more likely to be a racial or gender minority, to live in poverty, and to have less social support than their heterosexual peers. LGBT populations are disproportionately affected by mental health issues such as depression, which are correlated not only with behavioral risk factors, but with less likelihood to comply with healthcare screening or treatment. Approximately 30% of LGBT adults do not seek health care services or lack a regular health care provider, compared with 10% of heterosexuals. Research studies demonstrate that knowledge about increased risks and need for screening is low in LGBT populations. Sub-populations are less likely to have had a recent mammogram, anal or cervical Pap, or a prostate exam. Methods: We implemented a population-oriented program into our community outreach team in 2019 to address LGBT cancer disparities. A program manager partnered with community resources and leaders, including the Cleveland LGBT Community Center, Plexus LGBT Chamber of Commerce, and Trans Ohio. First year programming included a mammogram clinic for sexual/gender minority (SGM) women, “Cancer is a DRAG” show, and a tobacco-free campaign for LGBT pride month. Results: Creating meaningful partnerships was extremely important to community leaders and organizations. Strategic plans include direct community input and engagement through a community council, in conjunction with the LGBT Community Center, a breast cancer awareness campaign, in conjunction with local entertainers, and a tobacco cessation program, through our Center for LGBT Care. We educated over 150 people and screened over 85 within the first year. Conclusions: When our healthcare institution met local LGBT people within their community, the result was quite impactful. This pilot program proved successful at educating members of the community about their increased cancer risk, which resulted in higher cancer screening rates for LGBT people. More programs tailored to LGBT-specific health concerns are important to continue reaching these populations and eventually decrease health disparities in the community.

App-Based Tracking of Self-Reported COVID-19 Symptoms: Analysis of Questionnaire Data.

BackgroundCOVID-19 is an infectious disease characterized by various clinical presentations. Knowledge of possible symptoms and their distribution allows for the early identification of infected patients.ObjectiveTo determine the distribution pattern of COVID-19 symptoms as well as possible unreported symptoms, we created an app-based self-reporting tool.MethodsThe COVID-19 Symptom Tracker is an app-based daily self-reporting tool. Between April 8 and May 15, 2020, a total of 22,327 individuals installed this app on their mobile device. An initial questionnaire asked for demographic information (age, gender, postal code) and past medical history comprising relevant chronic diseases. The participants were reminded daily to report whether they were experiencing any symptoms and if they had been tested for SARS-CoV-2 infection. Participants who sought health care services were asked additional questions regarding diagnostics and treatment. Participation was open to all adults (≥18 years). The study was completely anonymous.ResultsIn total, 11,829 (52.98%) participants completed the symptom questionnaire at least once. Of these, 291 (2.46%) participants stated that they had undergone an RT-PCR (reverse transcription-polymerase chain reaction) test for SARS-CoV-2; 65 (0.55%) reported a positive test result and 226 (1.91%) a negative one. The mean number of reported symptoms among untested participants was 0.81 (SD 1.85). Participants with a positive test result had, on average, 5.63 symptoms (SD 2.82). The most significant risk factors were diabetes (odds ratio [OR] 8.95, 95% CI 3.30-22.37) and chronic heart disease (OR 2.85, 95% CI 1.43-5.69). We identified chills, fever, loss of smell, nausea and vomiting, and shortness of breath as the top five strongest predictors for a COVID-19 infection. The odds ratio for loss of smell was 3.13 (95% CI 1.76-5.58). Nausea and vomiting (OR 2.84, 95% CI 1.61-5.00) had been reported as an uncommon symptom previously; however, our data suggest a significant predictive value.ConclusionsSelf-reported symptom tracking helps to identify novel symptoms of COVID-19 and to estimate the predictive value of certain symptoms. This aids in the development of reliable screening tools. Clinical screening with a high pretest probability allows for the rapid identification of infections and the cost-effective use of testing resources. Based on our results, we suggest that loss of smell and taste be considered cardinal symptoms; we also stress that diabetes is a risk factor for a highly symptomatic course of COVID-19 infection.

When there is no sleep: forced migration and the social determinants of health during post-migration

Abstract Attending to and addressing the public health needs of forced migrants, especially those who experience torture due to their identities as sexual minorities, is increasingly challenging in socio-political landscapes that may negatively impact access to health resources and health care services. A great deal of public health intervention work has focused on pre-migration and migration contexts but post-migration contexts remain less developed in regards to the social determinants of health. The significance of post-migration challenges to refugee and asylum seekers' health need to integrate social determinants of health frameworks that meaningfully engage with the risk and protective factors in the complex sociocultural conditions in post-migratory experiences that include social, economic and political factors that impinge on housing, legal representation, employment, education food security and health access. This presentation provides findings from an integrated biopsychosocial and spiritual intervention that focused on LGBTQ refugee and asylum-seeking populations seeking health care services at a health clinic in North America. These findings recommend horizontal approaches that engage in transdisciplinary teams that address physical, emotional, social, spiritual and mental health arenas to engage in a social determinants of health framework. Key messages Integrated, trauma-responsive biopsychosocial and spiritual interventions may be most effective post-migration. Increased public health activism must support post-migration health interventions.

Women who inject drugs in Russia: stigma as a barrier in access to HIV and drug treatment services

Abstract Background There are over one million people living with HIV in Russia. People who inject drugs experience major disparities in their susceptibility to the virus and in their access to HIV services. Women who inject drugs (WWID) have been shown to be at heightened susceptibility to HIV, through both unsafe drug use and unprotected sex. Less is known about the social determinants of engagement in care specifically among WWID. Methods We conducted a qualitative research study in St. Petersburg in order to assess what factors influence engagement in HIV-related and drug rehabilitation services. We conducted in-depth interviews with 20 service providers and 30 WWID from June-November 2018. We recruited providers to represent a range of services, including government clinics, non-governmental organizations, and family services. We recruited WWID through community outreach services. We used thematic analysis and a team-based approach to coding data. Results A major theme across our data was the stigma and discrimination that WWID experience in their everyday lives and in their interactions with the healthcare system. WWID are subjected to stigmatization related to gender norms about drug use, the capacity to fulfill their roles as mothers, (for some) engagement in sex work, and (for some) HIV-positive serostatus. WWID are often reluctant to seek HIV-related services, including testing and treatment, out of fear of being treated poorly because of their drug use. The omnipresent societal stigma manifests into self-stigmatization and many WWID questioned their deserving of and abilities to seek healthcare services, including drug rehabilitation and HIV-related care. Conclusions Interventions are needed to address the stigma and discrimination that WWID in Russia experience in families, communities, and health institutions. Additionally, psychosocial interventions may help to address the self-stigmatization that sometimes influences WWID's self-efficacy to seek services.

Barriers in access to healthcare services for individuals with disorders of sex differentiation in Bangladesh: an analysis of regional representative cross-sectional data

BackgroundWorldwide people in disorder of sex development (DSD) faces multiple barriers while seeking their social rights, particularly healthcare services. We aimed to explore the healthcare opportunities available to them, using patterns of healthcare utilization and difficulties faced by DSD population in accessing healthcare services in Bangladesh.MethodsData from a total of 945 DSD population and 71 medical staff were analyzed, collected from three major divisions (Dhaka, Chittagong, and Rajshahi) in Bangladesh during the period of January to December of 2017. A structured questionnaire was used to collect data via face-to-face interviews. Descriptive statistic was used to determine the frequencies of the visit by the DSD population in healthcare facilities as well as to analyze difficulties experienced by the DSD population in getting healthcare services. Multivariate regression analysis was used to explore the association between perceived barriers in getting healthcare services and failures of the DSD population to receive the healthcare services.ResultsPresent data revealed that around 80% of DSD population sought healthcare services from government healthcare facilities, where the overall success rate in getting healthcare services was less than 50%. The DSD population reported a number of reasons for failures in getting healthcare services, including non-friendly interaction by non-clinical hospital’s staff, non-friendly interaction by physicians, public fright as general people do not want to mingle with a DSD person, undesirable excess public interest in DSD individuals, and limitation of the treatment opportunities of hospitals to merely male or female patients. Among the stated reasons, the most frequently reported reason was non-friendly interaction by physicians (50.27%), followed by undesirable excess public interest in DSD individuals (50.16%).ConclusionDSD population in Bangladesh have limited access to healthcare facilities and facing multiple barriers to get healthcare services. Initiatives from the government and social organizations are important to ensure their access to healthcare services.

Patients' Perceptions of Different Information Exchange Mechanisms: An Exploratory Study in the United States.

Patients may seek health care services from various providers during treatment. These providers could serve in a network (affiliated) or practice separately (unaffiliated). Thus, using secure and reliable health information exchange (HIE) mechanisms would be critical to transfer sensitive personal health information (PHI) across distances. Studying patients' perceptions and opinions about exchange mechanisms could help health care providers build more complete HIEs' databases and develop robust privacy policies, consent processes, and patient education programs. Due to the exploratory nature of this study, we aim to shed more light on public perspectives (benefits, concerns, and risks) associated with the four data exchange practices in the health care sector. In this study, we compared public perceptions and expectations regarding four common types of exchange mechanisms used in the United States (i.e., traditional, direct, query-based, patient-mediated exchange mechanisms). Traditional is an exchange through fax, paper mailing, or phone calls, direct is a provider-to-provider exchange, query-based is sharing patient data with a central repository, and patient-mediated is an exchange mechanism in which patients can access data and monitor sharing. Data were collected from 1,624 subjects using an online survey to examine the benefits, risks, and concerns associated with the four exchange mechanisms from patients' perspectives. Findings indicate that several concerns and risks such as privacy concerns, security risks, trust issues, and psychological risks are raised. Besides, multiple benefits such as access to complete information, communication improvement, timely and convenient information sharing, cost-saving, and medical error reduction are highlighted by respondents. Through consideration of all risks and benefits associated with the four exchange mechanisms, the direct HIE mechanism was selected by respondents as the most preferred mechanism of information exchange among providers. More than half of the respondents (56.18%) stated that overall they favored direct exchange over the other mechanisms. 42.70% of respondents expected to be more likely to share their PHI with health care providers who implemented and utilized a direct exchange mechanism. 43.26% of respondents believed that they would support health care providers to leverage a direct HIE mechanism for sharing their PHI with other providers. The results exhibit that individuals expect greater benefits and fewer adverse effects from direct HIE among health care providers. Overall, the general public sentiment is more in favor of direct data transfer. Our results highlight that greater public trust in exchange mechanisms is required, and information privacy and security risks must be addressed before the widespread implementation of such mechanisms. This exploratory study's findings could be interesting for health care providers and HIE policymakers to analyze how consumers perceive the current exchange mechanisms, what concerns should be addressed, and how the exchange mechanisms could be modified to meet consumers' needs.

Healthcare-related stigma among men who have sex with men and transgender women in sub-Saharan Africa participating in HIV Prevention Trials Network (HPTN) 075 study

ABSTRACT The inability to access health services when needed is a critical barrier to HIV prevention, treatment and care among men who have sex with men (MSM) and transgender women (TGW). Using data collected in HPTN 075, we explored factors associated with any experienced healthcare-related stigma. HPTN 075 was a cohort study to assess the feasibility of recruiting and retaining MSM and TGW in clinical trials in sub-Saharan Africa. Of 401 MSM and TGW enrolled at four sites (Kisumu, Kenya; Blantyre, Malawi; Cape Town, Soweto, South Africa) 397 contributed to the analysis (79.9% cis-gender and 20.1% TGW). Of these, (45.3%; 180/397) reported one or more of healthcare-related stigma experiences. Most frequently reported experiences included fear to seek healthcare services (36.3%) and avoiding seeking such services because of the discovery of MSM status (29.2%). Few men and TGW (2.5%) reported having been denied health services because of having sex with men. In multivariable analysis, more participants in Soweto [adjusted odds ratio (AOR) = 2.60] and fewer participants in Blantyre (AOR = 0.27) reported any healthcare-related stigma experiences, in comparison to participants in Kisumu. MSM and TGW that did not have a supportive gay community to rely on were more likely to report any healthcare-related stigma experiences (AOR = 1.46), whereas MSM and TGW who reported high social support and who never had engaged in transactional sex were less likely to report such experiences (AOR = 0.76 and AOR = 0.43, respectively). Our results suggest that encouraging support groups for MSM and TGW as well as training and sensitizing healthcare staff, and the general community, on MSM and TGW health issues and cultural competence may reduce stigma, improve access to healthcare, which could ultimately reduce HIV transmission.

Dementia and revivalist Islam: New perspectives to understanding dementia and tackling stigma

The notion of stigma and its influence on the understanding of dementia has commonly been recognized as a great challenge to seeking healthcare services for South Asians in England. The aim of this commentary is to examine how Muslims view, understand and tackle dementia stigma in the context of revivalist Islam, especially among Bangladeshi Muslims within their British communities. This article reflects on the interrelationship between dementia and revivalist Islam among Bangladeshi family caregivers and addresses the question of how revivalist Islam is a significant source of understanding dementia and tackling stigma. Bangladeshi caregivers show a practical attitude toward dementia which is generally acknowledged as a medical symptom, and for which family caregivers voluntarily seek healthcare support. This piece highlights underlying principles of caregivers religious beliefs in the acceptance of dementia as a disease, and in help-seeking which is influenced by Qur'anic verses and Prophetic traditions. Bangladeshi caregivers' religious beliefs intertwine with their knowledge, perception, and attitudes toward caregiving for their relatives with dementia. Revivalist Islam offers family caregivers an opportunity to explore their inner wisdom through the challenging journey of caregiving for their family members with dementia.

Effect of previous emergency psychiatric consultation on suicide re-attempts – A multi-center observational study

BackgroundThe emergency department (ED) is one of the first gateways when suicide attempt patients seek health care services. The purpose of this study was to analyze the hypothesis that people who received emergency psychiatric services in previous suicide attempts will have a lower mortality rate in current ED visits owing to subsequent suicide attempts. MethodThis retrospective study included patients who visited six EDs, and participated in the injury surveillance and in-depth suicide surveillance for 10 years, from January 2008 to December 2017. The study subjects were adult patients 18 years or older who visited EDs due to suicide attempts. The main explanatory variable is whether psychiatric treatment was provided in previous suicide attempts. The main outcome variable was suicide related mortality. ResultsThe study included 2144 suicide attempt patients with a previous history of suicide attempts. Among these, 1335 patients (62.2%) had received psychiatric treatment in previous suicide attempts. Mortality was significantly different between the psychiatric consultation group (n = 33, 2.5%) and non-consultation group (n = 47, 5.8%) (P < 0.01). In multivariate logistic regression analysis, previous psychiatric consultation showed a significant association with low mortality (adjusted OR 0.41; 95% CI [0.23–0.72]) and selecting non-fatal suicide methods (adjusted OR 0.47; 95% CI [0.36–0.61]). ConclusionPatients who received psychiatric consultation in previous suicide attempts had a lower suicide-related mortality in current ED visits as compared to patients who did not, and this may have been related to choosing non-fatal suicide methods.

Emotional problems and the use of psychotropic drugs: investigating racial inequality.

The aim of the present study was to investigate the existence of racial inequalities in the prevalence of emotional problems, the search for healthcare services and the use of psychotropic drugs. A population-based, cross-sectional study was conducted with data from the 2014/15 Campinas Health Survey. Sample of 1953 individuals aged 20 years or older was analyzed. We estimated the prevalence of common mental disorders (CMDs), the reporting of emotional problems, insomnia, the search for and the use of healthcare services and the use of psychotropic drugs according to self-reported skin color (white and black/brown). Prevalence ratios were estimated using "Poisson" multiple regression. The prevalence of CMDs was higher among blacks/brown compared to whites but no difference was found regarding the reporting of emotional problems and insomnia. Whites sought healthcare services more due to emotional problems. The use of psychotropic drugs was also higher among whites. The results revealed racial inequalities in the presence of CMDs, the search for healthcare services and the use of psychotropics drugs, highlighting the need for actions to identify and overcome barriers that hinder access to mental health care by different racial segments of the population.

A Quality Improvement Project for Care Transitions of Incarcerated Women [03C

INTRODUCTION: Currently incarcerated pregnant women face significant barriers when they seek health care services within prisons and jails, but little is known about transitions from state prison health care systems to outside hospitals. METHODS: With the goal of developing a policy to improve these transitions, we conducted in-depth interviews with key stakeholders at a state prison, university hospital, and local private hospital to identify the barriers and facilitators to care transitions for incarcerated pregnant women. RESULTS: Key themes emerging from the interviews were operational, including transfer of medical records, communication between systems, and education of providers, and structural, including care of marginalized populations and implicit biases. CONCLUSION: Policy changes to improve transitions of care may include the addition of a dedicated pregnancy care coordinator and a standardization of a clinician-to-clinician sign-out process. This work has the potential to motivate changes to the policies that govern care of incarcerated pregnant women, and stimulate the delivery of more effective and efficient health care to this population.

Seeking Care at Free Episodic Health Care Clinics in Appalachia.

BackgroundPeople who live in rural Appalachia experience a wide variety of problems when seeking access to health care. Health care disparities continue to be one of the most complex and prevalent problems, and many barriers exist for impoverished men and women such as a lack of education, complications with health insurance, and personal distrust of healthcare providers.PurposeA critical gap in the literature is the unheard voice of persons in rural underserved areas. The purpose of this study was to explore the perspectives of persons in rural Appalachia who seek healthcare services at free episodic health care clinics, a common alternative source of care.MethodsIn Fall 2017, a qualitative approach was used to discover the perceptions of 12 men and women in rural Appalachia who were seeking medical care at a Remote Area Medical Clinic. A transdisciplinary research group provided insight and assistance with thematic analysis in Spring 2018–Spring 2019.ResultsFive overall themes emerged capturing the essence of how rural Appalachians view the experience of seeking healthcare, which include difficulties with insurance/finances, inconsistency in care, isolation in rural areas, seeking solutions, and need to feel valued.ImplicationsA rich description of participant experiences portrays real-life complexities for Appalachian men and women who seek healthcare. Understanding the perceptions of persons who seek healthcare and the essence of their experiences is the first step in determining future sustainable solutions for social justice.

Using Theater as an Educational Tool for Understanding Medication Experiences from the Patient Perspective

Objective. To develop a play depicting patients' medication experiences and evaluate its usefulness as an educational tool for improving health care professionals' understanding of medication experiences from the patient perspective. Methods. An award-winning playwright was recruited to write the script, which was based on 2,178 written comments submitted by respondents to a national consumer survey on patients' medication experience and pharmacist roles. The resulting play, Go Ask Alice, was presented during November 2016 in two Minnesota cities. Attendees were asked to complete a survey before and after the performance and to provide their email address if interested in completing a three-month follow-up survey. The research team conducted descriptive and inductive thematic analyses on the quantitative and qualitative data, respectively. Results. A total of 225 people viewed the performances, with 161 completing both the pre- and post-intervention surveys and 58 providing feedback three months later. Two themes emerged in the follow-up survey: the play illuminated barriers that patients face when seeking health care services, as well as the major hindrances and other contributors to patients' medication experiences. Conclusion. Theatrical performance can be an effective educational tool for understanding medication experiences from the patient perspective.

GPER‐mediated, oestrogen‐dependent visceral hypersensitivity in stressed rats is associated with mast cell tryptase and histamine expression

Visceral hypersensitivity (VH) is common in irritable bowel syndrome (IBS), and female patients are more likely to seek healthcare services for IBS-related abdominal pain. Oestrogen has been reported to mediate pain modulation via its receptor, and mast cells are known to participate in the development of visceral hypersensitivity. Our previous studies showed that the G-protein-coupled oestrogen receptor (GPER, also known as GPR30) was expressed by mast cells in human colonic tissues and was associated with IBS type and severity of visceral pain. However, whether GPER is involved in oestrogen-dependent visceral hypersensitivity via mast cell degranulation is still unknown. Rats were subjected to wrap partial restraint stress to induce visceral hypersensitivity and were ovariectomized (OVX) to eliminate the effects of oestrogen on visceral hypersensitivity. OVX rats were treated with oestrogen, an oestrogen receptor α and β antagonist (ICI 182.780), a GPER antagonist (G15) or a GPER agonist (G1), to evaluate the effects of oestrogen via its receptor. The colorectal distention test was performed to assess visceral sensitivity. Immunofluorescence studies were performed to evaluate GPER and mast cell tryptase co-expression. Mast cell number with degranulation was detected by specific staining. Mast cell tryptase expression in rat colon was also investigated by Western blot and immunohistochemistry. Substance P and histamine expression were examined by ELISA. GPER was expressed by the majority of tryptase-positive mast cells in the colonic mucosa. Stressed rats showed increased visceral sensitivity, increased mast cell degranulation, mast cell tryptase expression, and increased colon histamine levels. Ovariectomy reduced stress-induced VH in female rats and decreased mast cell degranulation, mast cell tryptase expression, and histamine levels, whereas oestrogen replacement reversed these effects. In OVX rats, the GPER antagonist G15 counteracted the enhancing effects of oestrogen on stress-induced VH, mast cell degranulation, mast cell tryptase, and histamine expression, whereas VH was preserved after treatment with ICI 182.780. On the other hand, pretreatment with the selective GPER agonist G1 at doses between 1 and 20μg/kg significantly increased VH, mast cell tryptase, and histamine expression in OVX-stressed rats, mimicking the effects of oestrogen. GPER plays a pivotal role in the regulation of mast cell degranulation, mast cell tryptase expression, and histamine levels and contributes to the development of colonic hypersensitivity in a female rat model of IBS.