Utilization Of Support Services Research Articles

Adult Cancer Patients' Perceptions of Factors That Influence Hospital Admissions.

To explore cancer patients' perceptions of factors that influence hospital readmissions. A cross-sectional, prospective design was employed utilizing a 1-time survey and brief interviews to measure patients' perceptions and unplanned hospital admissions. The principal investigator collected data from medical record review, the Hospital Admission Survey, and interviews to measure patient characteristics and perceptions of influencing factors that contributed to an unplanned hospital admission upon admission. Data were analyzed using descriptive statistics to categorize patient perceptions of influencing factors of unplanned hospital admissions. The top reasons for admission were symptoms of uncontrolled gastrointestinal, pain, fever, and respiratory problems. The majority perceived the admission was unavoidable and wanted to avoid an admission. Perceived influencing factors were related to survey categories of 1) communication (ie, cannot reach physician anytime, cannot get a next-day appointment, medical problems are out of control, advised to go to the emergency department) and 2) home environment (ie, unable to adequately manage symptoms at home and hospital admission is the best place for care). Other survey categories of patient education and palliative care were not perceived as influencing or contributing factors. These findings highlight opportunities for clinical nurse specialists to target these vulnerable patients and provide expert consultation to address potential barriers and gaps in utilization of appropriate supportive services that may reduce unplanned hospital admissions.

Electronic health intervention to manage symptoms of immunotherapy in patients with cancer (SOFIA): Results from a randomized controlled pilot trial.

For patients receiving immune checkpoint inhibitors, early detection of immune-related adverse events (irAEs) is critical for one's safety. To this end, a smartphone app (SOFIA) was developed that featured the assessment of electronic patient-reported outcomes (ePROs) focusing on irAEs as well as a set of comprehensive supportive information. Its feasibility and preliminary efficacywere evaluated in a randomized controlled trial (RCT). Patients who received immune checkpoint inhibition therapy were randomly assigned to an intervention group (IG) or a control group (CG; care as usual). During the 12-week intervention period, IG patients used SOFIA to report twice weekly ePROs and receive cancer- and immunotherapy-relevant contents. Before a patient's next clinical visit, the physician in charge was given the ePRO reports. The primary objective was to test the feasibility of SOFIA. Furthermore, the preliminary efficacy of SOFIA for health-related quality of life (HRQOL), psychosocial outcomes, and medical data was examined. Clinical outcomes were assessed at baseline (T0), post-intervention (T1), and a 3-month follow-up (T2). Seventy-one patients were randomized to the IG (n=34) or the CG (n=37). SOFIA showed high feasibility and acceptance. At T1, patients in the IG reported significantly better HRQOL and role functioning and less depression, distress, and appetite loss. No significant differences were revealed regarding medical data, the utilization of supportive care services, or survival. SOFIA showed high feasibility and acceptance and improved HRQOL and psychosocial outcomes. These results suggest further evaluation of efficacy in a large-scale confirmatory multicenter RCT.

ECCE Principals' Strategy to Improve Teacher Competence in Implementing the Independent Curriculum

This study aims to investigate the strategies used by Early Childhood Care and Education (ECCE) principals in Kecamatan Arcamanik, Bandung, to enhance teacher competence for the Independent Curriculum. Utilizing a qualitative approach with case study method, observation and semi-structured interviews were conducted with principals from 10 ECCE institutions, supplemented by the review of relevant documents and institutional records. The data were analyzed thematically, drawing upon current educational research to contextualize the findings within broader educational theory and practice. The findings reveal a diverse range of strategies employed by the principals, including the provision of educational resources, ongoing professional development, collaborative learning, and the utilization of support services and platforms. These strategies vary in their alignment with current educational research, reflecting the unique context of each institution. The study highlights the importance of tailoring teacher development strategies to meet the specific needs and resources available to educational institutions. Implications of this study are significant for both policymakers and practitioners, particularly in Indonesia and similar contexts.

Examining sexual minority engagement in recovery community centers

IntroductionResearch indicates that sexual minority (SM) individuals with alcohol and other drug use disorders may underutilize recovery resources generally but be more likely to use recovery community centers (RCCs). To inform recovery supports, this study characterized SM and heterosexual RCC members by demographics and clinical and recovery support service utilization. MethodsCross-sectional secondary analyses compared SM and heterosexual RCC members in the northeastern U.S. (n = 337). Qualitative analyses coded the top three recovery facilitators. ResultsOf the 337 participants (Meanage[SD] = 40.98[12.38], 51.8 % female), SM RCC members were more likely than heterosexuals to endorse lifetime psychiatric diagnoses and emergency department mental health treatment (p < .01). RCC service utilization and qualitatively derived recovery facilitators were mostly consistent across groups. ConclusionsRCCs engaged SM individuals in recovery in ways consistent with heterosexuals. Despite otherwise vastly similar demographic characteristics across sexual identity, findings suggest a need for additional mental health resources for SM individuals in recovery.

The Influence of HIV/AIDS Care and Support Services Accessibility on Utilization among HIV Infected Adults in Baringo County, Kenya

Context: Globally, efforts are being made to end the HIV/AIDS pandemic and improve the general health of people living with HIV/AIDS through continuous access to care and support services. However, the incidence of dropouts from utilization of HIV care and support services is rising among the HIV-positive clients enrolled in comprehensive care clinics in Baringo County for unidentified reasons. As a result, recognizing the opportunities and challenges in low-resourced communities that must be overcome to promote greater access to care and treatment will influence higher utilization.&#x0D; Aim: This study evaluates the influence of accessibility of HIV/AIDS care and support services on the utilization of HIV-infected adults in Baringo County.&#x0D; Methods: The study was conducted in Baringo County HIV comprehensive care centers. An analytical cross-sectional study design was used with 580 participants recruited. An interviewer-administered questionnaire was used to obtain data.&#x0D; Results: Support from social services (p&lt;0.0001), less frequent visits to clinics less than one month (p&lt;0.0001), access to treatment interventions (p&lt;0.0001), and easily accessible information (p &lt;0.0001) were among the factors associated with good accessibility to HIV services, according to bivariate analysis. Conversely, being an atheist (p&lt;0.006), residing in rural areas (p ≤0.0006), difficulty accessing services (p≤0.0001), and getting to another town (p &lt; 0.03) or getting to another county (p ≤0.0004) were linked to inadequate access to HIV/AIDS care and support services.&#x0D; Conclusion: The findings show that the efforts to support clients' access to HIV/AIDS care and support services should be made in response to their individual needs and consideration of geographical location. Besides, individualized HIV/AIDS services access depends on the support provided, where they are located, easily accessible information about the services, and how frequently they are provided. In contrast, living in rural areas, seeking services in a different town, feeling ashamed to visit clinics, and having a lower CD4 count were all associated with poor accessibility and utilization of HIV/AIDS care and support services. Consequently, it is necessary to establish support initiatives to address any of these access issues that particular clients might have.

Association between home and community-based services utilization and self-rated health among Chinese older adults with chronic diseases: evidence from the 2018 China Health and Retirement Longitudinal Study

BackgroundAs global aging intensifies, older adults with chronic diseases are of increasing concern. Home and community-based services (HCBSs) have been proven to promote self-rated health (SRH) in older adults, but no research explored the associations between the use of overall HCBSs, three different types of HCBSs (health care, daily care, and social support services) and SRH among older adults with chronic diseases. Consequently, this study applies a national publicly available database to examine these associations among older adults with chronic diseases.Methods8,623 older adults with chronic diseases (≥ 60 years old) were included in this study. SRH was evaluated applying a concise question with a 1 − 5 scale. HCBSs utilization was assessed through the question, “What kind of HCBSs were used in the community?”. Univariate general linear regression models aimed to compare the mean values of SRH in terms of HCBSs utilization in each group. This study is a cross-sectional study design and the relationship between HCBSs utilization and SRH was assessed by multilevel linear regression.ResultsThe mean score for SRH among the respondents was 3.19, of whom 20.55% used one or more HCBSs, 19.47% utilized health care services, 2.44% utilized social support services, and only 0.55% utilized daily care services. The use of HCBSs was found to be linked to SRH among older adults with chronic diseases (β = 0.085, SE = 0.025, p < 0.001). SRH among older adults with chronic diseases was strongly linked to the use of health care and social support services (β = 0.068, SE = 0.025, p < 0.001; β = 0.239, SE = 0.063, p < 0.001, respectively). However, there was no significant association between the use of daily care services and SRH among older adults with chronic diseases.ConclusionThis study revealed that HCBSs utilization was positively and significantly linked to SRH in Chinese older adults with chronic diseases. Furthermore, this study supposes the low utilization of social support and daily care services may be due to a mismatch between supply and demand. The government should offer the targeted HCBSs for older adults with chronic diseases according to their unique features to enhance their health status.

INDIVIDUAL AND COUNTY-LEVEL FACTORS OF SERVICE USE BY DEMENTIA FAMILY CAREGIVERS IN RURAL APPALACHIA

Abstract Formal services have been shown to provide health benefits for care recipients and family caregivers. Despite prior efforts, it is still unclear which factors play a role in the decisions to use formal services by family caregivers living in under-resourced rural regions. Drawing upon the Andersen model of health service use, this study examined individual and county-level factors’ associations with the utilization of support services (e.g., homemaker, respite) and personal services (e.g., home health nurse, personal care aide) by dementia family caregivers residing in rural Appalachia (N = 163). Results of multilevel models revealed that caregivers with higher income and care recipients with more limitations in activities of daily living tended to use more support and personal services. Greater informal support from family or friends was associated with less utilization of support services, but not personal services. Caregivers residing in counties with higher poverty and lower public spending on support services for older adults were more likely to use support services. Conversely, caregivers living in counties with more home health agencies were more likely to utilize personal services. These findings suggest that caregivers living in rural regions may depend more on informal support for meeting basic care needs of their relative living with dementia. However, if the care recipient requires more specialized care, living in resource-rich counties increases their chances of receiving appropriate care. Discussion will focus on strategies to allocate funds and resources to expand care coverage to vulnerable individuals such as people living with dementia in rural regions.

CAREGIVER IDENTITY IN EMERGING ADULTHOOD: HOW IDENTITY DISCREPANCY AND SALIENCE RELATE TO DISTRESS

Abstract As the older adult (age 65+) population grows in the United States, the demographics of caregivers are expanding to include more emerging adults (ages 18-25) who are participating in caregiving tasks. Minimal research has focused on this subgroup of caregivers to older adults, especially with regards to understanding factors that may influence their levels of caregiver distress. Guided by caregiver identity theory, the current study examined 1) the relationship between caregiver identity and caregiver distress, 2) support service utilization as a mediator between caregiver identity and caregiver distress, and 3) the inclusion of ageist attitudes within caregiver identity models. A sample of 259 emerging adult caregivers were recruited through Amazon MTurk. Fit of the hypothesized structural equation model was acceptable and squared multiple correlations (R2) indicated that 73.1% of the variance in caregiver distress, 23.8% of the variance in support service utilization, and 22.7% of the variance in ageist attitudes was explained by this model. Higher caregiver identity salience was significantly related to lower caregiver distress. Support service utilization partially mediated the relationship between identity salience and distress through an inconsistent mediation. The findings of the current study support caregiver identity as a unique, multidimensional process consisting of both identity discrepancy and salience latent constructs. Results showed low-to-moderate caregiver identity discrepancy, possibly due to identity flexibility during this developmental period. High caregiver identity salience was protective against caregiver distress for emerging adults. Ageist attitudes warrant inclusion in future research on caregiving identity development. Implications for support services are discussed.

FACTORS ASSOCIATED WITH SERVICE UTILIZATION AMONG OLDER ADULTS WITH FUNCTIONAL OR COGNITIVE IMPAIRMENT

Abstract Social services (e.g., senior centers, adult day care centers) and home health services (e.g., in-home personal care, visiting nurses) have been found to provide numerous benefits, such as opportunities for social interaction, physical activity, cognitive stimulation, as well as personal care and regular medical check-ups for older adults. These services may have greater positive impacts among older adults with disabilities or impairments given their limited mobility and reduced capacities to perform daily tasks. However, as most previous studies have focused on the general population, our understanding of factors associated with service utilization among those with disabilities or impairments is limited. This study examined individual characteristics associated with social and home health service utilization among older adults with functional limitations or cognitive impairments using data from the Health and Retirement Study. Results from logistic regression models suggest that older age and being not married were positively associated with utilization of both social and home health services, while being foreign-born was negatively associated with the outcomes, adjusting for sociodemographic characteristics. Respondents with higher educational attainment tend to use social services more and are less likely to use home health services than those with less than a high school education. Rural residence was negatively associated with the utilization of social services, but not with home health services. Providing information on available services and enhancing access by increasing the number of service providers, transportation options, and financial assistance would promote utilization of supportive services among older adults with functional limitations and cognitive impairments.

Utilization and costs of health care and early support services in Germany and the influence of mental health burden during the postnatal period

Limited evidence is available about health care utilization and its determinants in the vulnerable postnatal period for mothers and their children. Thus, the aim of our analyses was to assess determinants of health care and early support services utilization regarding mothers and their children and associated costs in the postnatal period in Germany. Moreover, we aimed to investigate the impact of noticeable mental health and psychosocial burdens on health care and early support services utilization and costs. Using a two-step assessment process of parents from a randomly selected sample of 30,000 recently born children in the multicenter observational population-based cohort study of the SKKIPPI project, we firstly identified mothers who were potentially at risk of mental health and psychosocial burden. These mothers were then invited to participate in an in-depth assessment, including a detailed self-developed questionnaire focusing on early support and health care services utilization. A follow-up after 6 months was conducted. Potential determinants of early support services utilization were analyzed using logistic regression. General linear models with gamma distribution and log link functions were applied to analyze potential determinants of health care costs and to estimate mean adjusted costs. Mothers with a noticeable mental health or psychosocial burden and their children caused mean early support services costs of €1073 and caused total costs of €10,849 in the postnatal period from a payer’s perspective compared to €349 (early support services) and €9136 (total costs) for mothers without a noticeable mental health or psychosocial burden and their children. The main determinants of total costs were facing a chronic disease (child), preterm delivery, bad experiences with doctors and midwives, and single parenthood. The majority of participants (69 %) utilized some kind of early support services. The most important determinants of early support service utilization in the postnatal period with respect to the children were facing a chronic disease, being the first child, and being born as a twin. Our findings highlight the importance of sufficient appreciation and treatment of mental health problems in the postnatal period from both a societal and payer’s perspective. Future research should investigate whether these and more specific interventions could be a cost-effective way to support mothers with mental health or psychosocial burden and their children.

Assessment of Incidence of Distress and Utilization of Supportive Care Services in Multiple Myeloma Patients, a Retrospective Single Center Experience

Introduction: Multiple myeloma (MM) is the second most common hematological malignancy. Current literature represents substantial underutilization of guideline-recommended supportive services (SS) in MM patients. Earlier studies have shown that most patients with MM have focal osseous lesions leading to skeletal-related events, fractures, pain, and debility. These events may negatively affect the treatment course and result in poor quality of life. Recent NCCN and ASCO guidelines recommend utilization of SS in all patients by early integration of cancer care for symptom control while being treated for primary malignancy. We evaluated the level of distress in patients (pts), SS utilization, ED visits, and hospitalization in pts with MM. Methods: We included adult patients (≥18 years) with newly diagnosed or relapsed/refractory MM at Levine Cancer Institute who had completed an electronic distress survey (EDS) within three months of diagnosis or relapse. Amyloidosis and plasma cell leukemia diagnoses were excluded. The EDS includes questions related to sociodemographic, patient-reported outcomes (PROs): distress level, physical symptoms (scale 0 - 10), screening for depression (PHQ-2, scale 0 - 6), anxiety (GAD-2, scale 0 - 6),Utilization of at least one SS (social work, palliative medicine, psych-oncology, cancer rehab, integrative medicine, and nutrition) within 6 months of EDS and emergency department visits/hospitalizations within 1 year of EDS were collected, retrospectively, from the electronic medical record. The PROs were summarized overall and compared among three distress groups [Distress score (DS) &amp;lt;4, 4-6, ≥7] with Wilcoxon rank sum tests for the EDS symptom scores and Fisher's exact tests for other categorical endpoints. Results: 541 MM pts were identified with an EDS within 3 months of diagnosis or relapse (assessment date range: January 2017 - May 2022), with 71.5% of those occurring near diagnosis, and 28.5% occurring around relapse. The mean age was 64.9 years, 58.6% were male, and additional patient characteristics are presented in Table 1. There were 33.8% (n=183) pts with DS&amp;lt;4, 30.9% (167) with DS 4-6, and 35.3% (191) with DS of ≥7. The highest scoring EDS symptoms were pain (mean score 4.7), fatigue (5.1) and sleep disturbance (3.6). Broadly, patients with higher distress scores had higher symptom scores (p&amp;lt;0.05 for all symptoms). There were 77.6% (420) pts with anxiety GAD-2 score of 0-2, 12.9% (70) pts with a score of 3-4 and 9.4% (51) pts with a score of 5-6. Similarly, for depression, 76.9% (416) pts reported a PHQ-2 score of 0-2, 15% (81) with a score of 3-4, and 8.1% (44) with a score of 5-6. For anxiety and depression, patients with higher DS had higher depression and anxiety screening scores (p &amp;lt;0.001), as shown in Table 2. 64.3% (348) pts utilized at least one SS within six months of their initial EDS assessment. The rate of utilization of at least one SS increased with DS (49.2% in DS &amp;lt;4, 67.1% in DS 4-6, and 76.7% in DS ≥7; p value&amp;lt;0.001). Numerically, more patients with high distress had at least one ED visit within a year of EDS (25.7% DS &amp;lt;4, 33.5% DS 4-6, 36.1% DS ≥7, p = 0.08). There was no significant difference in hospitalization within 1 year between the DS groups. There were 147 (36.8%) pts with high-risk cytogenetics, of which 43.5% had a distress score of ≥7. The rate of utilization of SS, ED visits, and hospitalizations was numerically higher in pts with newly diagnosed MM (68.5%, 34.4%, 63.1%, respectively), as compared to pts with RRMM (64.3%, 25.3%, 48.7%). Conclusion: The disease-specific symptoms predict clinically significant DS &amp;gt;4 on EDS. There were about 20% of pts with screening score &amp;gt;2 for anxiety (GAD-2) &amp; depression (PHQ-2) that may warrant further exploration regarding the detail and nature of symptoms related to the diagnosis. There was a higher rate of utilization of SS and ED visits in pts with higher DS. Given these findings, there is a need to identify the optimal healthcare pathways for better utilization &amp; incorporation of these EDS and PROs in the clinical care of distressed patients. Our study indicates that more work is needed to align needs with resources in order to optimize quality of life and disease outcomes for our pts.

Support of Veterans in STEM Degree Programs to Promote a Diverse and Skilled Workforce

More Americans are needed in STEM (Science, Technology, Engineering, Math) careers to advance the nation’s competitiveness in the global economy. Given the extensive training of military service members, this population is well-poised to transition into STEM careers. While many veterans pursue STEM degrees, they often face hardships that impact their ability to attain STEM credentials. The goal of this mixed methods study was to identify factors that contributed to attaining a STEM degree among students in the Military STEM Scholarship Program (MSSP), a grant-funded program implemented at a university in the United States to assist veterans pursuing STEM degrees. By targeting veterans, this program supported a highly diverse group of students. Based on surveys, focus groups, and interviews, the participants credited their academic and professional success to activities promoted by the MSSP program, such as peer interaction, faculty mentorship, utilization of student support services, and internships. As a result, 80% of MSSP participants obtained a STEM degree, approximately 24 percentage points higher than the institution’s average six-year graduation rate for all students. Through these findings, a model is offered for institutions to better serve a growing student veteran population.

Formal support services and (dis)empowerment of domestic violence victims: perspectives from women survivors in Ghana

BackgroundAs part of efforts to prevent violence against women, several countries have institutionalized formal support services including legislations to prevent, protect victims, and deter perpetrators of domestic violence (DV). Prior research on formal support service utilization shows that DV survivors do not get the necessary services they deserve. However, much remains to be known about the experiences of women survivors of DV who accessed a range of formal support services and how their experiences (dis)empowered them. Here, we assessed the experiences of Ghanaian women survivors of DV with formal support services vis-à-vis the provisions of the Ghana DV Act and insights of subject experts.MethodsFrom May to August 2018, we recruited a total of 28 participants: 21 women survivors of DV in Weija-Gbawe Municipality of Ghana, and 7 experts from the police, human rights, and health professions. We used two sets of in-depth interview guides: one to collect data on survivors’ experiences, and the second for the insights of experts. We performed summary descriptive statistics on survivors’ sociodemographic characteristics and used thematic analysis to assess their experiences of DV; and access to, patronage, and response of formal support services.ResultsOf 21 DV survivors, 19 (90.1%) were aware of the existence of the DV law, however none was well informed of their entitlements. DV survivors have low formal education and are not economically empowered. Some DV survivors are revictimized in the process of accessing formal services. DV survivors expect the government to provide them with shelter, upkeep, medical, and legal aid. All the 21 survivors had at least one contact with a women’s rights organization and were knowledgeable of their supporting services namely legal services, temporary shelter, and psychosocial support.ConclusionsThe experiences of DV survivors do not reflect the legal provisions of Ghana’s DV Act. Government under funding of formal services and negative gender norms are disempowering to survivors. NGOs are popular among women survivors of DV in Ghana for the education, legal, and material support they provide. A close collaboration between the government and NGOs could better mitigate DV in Ghana.

Leçons tirées d’une initiative de soutien linguistique spécifique à une discipline pour des étudiants et des étudiantes multilingues inscrits dans un cours de base de sciences de la santé : une étude de cas basée sur des méthodes mixtes dans une université de l’Ouest du Canada

This mixed methods explanatory case study intends to explain low utilization of a joint initiative to improve language skills targeted to English as an additional language (EAL)/multilingual students (MLSs) in a disciplinary context. Considering the importance of discipline-specific language and literacy skills, a university health sciences faculty and an English language learning centre at a western Canadian University collaborated on a joint initiative to support EAL/MLSs. Language support services, such as an extra semester-long adjunct language tutorial, drop-in language services, and language support files uploaded on the Canvas Learning Management System (LMS) were provided for students enrolled in a first-year introductory-level health sciences course. A comparison of a pre-test and post-test Post-Entry Language Assessment (PELA) revealed improvements in both writing skills and perceived language skills. However, the discovery of the underutilization of language support services prompted a sequential explanatory mixed methods case study to identify learners’ reasons for low participation. Findings from the quantitative survey and qualitative interviews are shared along with recommendations for improving language support service utilization.

Health Providers' Response to Female Adolescent Survivors of Sexual and Gender-Based Violence and Demand Side Barriers in the Utilization of Support Services in Urban Low-Income Communities of Nigeria.

Survivors of sexual and gender-based violence (SGBV) are often hindered in their quest to access quality healthcare. This has a significant effect towards the achievement of Sustainable Development Goal SDG Target 3.7. to ensure universal access to sexual and reproductive healthcare services. This study is focused on identifying some of the demand side barriers in accessing health care services, particularly among young girls who are survivors of SGBV within intimate relationships in poor urban areas in Nigeria. The study used an ethnographic approach to solicit information from health providers, adolescents, and young women (AYW) in 10 low-income communities in two major cities in Nigeria, Ibadan and Lagos. Findings showed that there are structural limitations within the primary health care (PHC) system that posed a great challenge for survivors of SGBV to access services. Some of these include non-existing counseling services, a lack of rehabilitation centers, poor referral, and a lack of training for health providers in handling survivors of SGBV. There is also a lack of skills among health service providers that have negative influence on support services to survivors of SGBV. On the demand side, poor knowledge of possible health seeking pathways, a lack of education, and social support are barriers to accessing appropriate services among adolescent and young SGBV survivors. The study concluded that integrated services at the PHC level should include adequate and timely treatment for survivors of SGBV and targeted intervention to upscale skills and knowledge of health care providers.

Prevalence and correlates of alcohol use, mental disorders, and awareness and utilization of support services among healthcare professionals in West Rand District, Gauteng, South Africa: a cross-sectional study.

Healthcare professionals (workers) are at an increased risk for developing mental and alcohol use disorders (risky drinking) due to increased psychological distress, long working hours, medical litigation, role conflict, and verbal/physical violence from colleagues and patients. Psychological well-being in healthcare workers is crucial to provide the best quality of care to patients. Current data are limited regarding alcohol abuse (risky drinking) rates and mental health condition among healthcare professionals in South Africa. To describe the prevalence and correlates of alcohol use disorder (risky drinking), depression, anxiety, suicidality, and covid anxiety during the coronavirus pandemic in healthcare professionals in West Rand District, Johannesburg, South Africa. We carried out a cross-sectional study on a sample of healthcare professionals including doctors, nurses, clinical associates, and dentists working in the West Rand District of Gauteng, South Africa, during Covid-19 pandemic. Participants were invited to complete a paper-based questionnaire addressing sociodemographic questions, a set of measures for alcohol use disorder (AUDIT-C), depression (PHQ-2), anxiety (GAD-7), suicidality (PSS-3), covid anxiety (CAS), and awareness and utilization of support services. A total of 330 healthcare professionals (60.9% nurses, 33% doctors, 5.5% other) participated. Females comprised the majority of study participants with 78.8%, and 48.2% of the participants were in the age band 35-64 years. Overall, 20.9% of the healthcare professionals reported risky alcohol use. Females were 73% less likely to report risky alcohol use (AOR = 0.27;95% CI: 0.13-0.54). Prevalence of probable depression was 13.6% and female professionals were 5 times more likely to be classified as having probable depression (AOR = 4.86;95% CI: 1.08-21.90). The grouped prevalence of anxiety ranging from mild to severe was reported at 47.3%, female professionals were 3 times more likely to be classified as having anxiety disorder (AOR = 2.78;95% CI: 1.39-5.57). Furthermore, races other than African had higher rates of anxiety (AOR = 2.54; 95% CI: 1.00-6.42). The prevalence of suicide symptoms was 7.9% and that of covid dysfunctional anxiety 4.8%. Only 5% of participants were involved in an employee wellness program, with 60% expressing interest in joining one. Alcohol use (risky drinking) and mental disorders were common among healthcare professionals in West Rand District, Johannesburg, South Africa. There is overall poor awareness and use of support structures highlighting urgent need for interventions. Future studies could also explore in-depth the drivers of mental disorders and lack of utilization of the available service and strategies to deliver alcohol and mental disorder screening, brief intervention, and referral to treatment.

Utilization of support services by gynecologic cancer survivors (1143)

Utilization of support services by gynecologic cancer survivors (1143)

Genetic Neuromuscular Disorders and Health Services Access, Utilization, and Needs in Zambia

BackgroundMedical and rehabilitative advances increasingly transform management of rare genetic neuromuscular diseases (GNMDs) for children in the global north. Lack of information about GNMDs and related health care needs in sub-Saharan Africa threatens to widen pre-existing health disparities. MethodsThis is a cross-sectional study of probands enrolling in a study of GNMDs at the University Teaching Hospital in Lusaka, Zambia, a member of the International Consortium for Genomic Medicine in Neuromuscular Disease. Probands/caregivers were interviewed about utilization of medical, rehabilitative, and other support services by a research assistant. A neuromuscular neurologist and/or physiotherapist examined each case and completed an independent questionnaire regarding health service utilization for each proband. Diagnoses were made on available clinical and electrophysiologic data. Molecular findings were unavailable at the time of this analysis. ResultsAmong 50 probands, 52% were male with median age 12 (absolute range 2 months to 54 years). Motor neuron diseases (n = 16; 32%), muscle disorders (n = 20; 40%), and inherited polyneuropathies (n = 5; 10%) were most common. Six (15%) cases had insufficient clinical data to classify the GNMDs. Outside of primary care, patient/caregiver-reported access to recommended health services (n = 34; 69%) was challenging. Large disparities in current utilization of health care services versus clinician-recommended services are reported. ConclusionsParadigms to improve access to diagnostics and therapeutic interventions are needed for GNMDs in Zambia. Multidisciplinary clinics may improve access and utilization of needed health services. Qualitative and other research focused on improving referrals, access, and quality of available health services are greatly needed.

Counseling and support services for healthcare workers in German university hospitals during the pandemic-descriptive results of a Germany-wide cross-sectional survey.

Due to the SARS-CoV-2 pandemic, healthcare workers (HCWs) are experiencing tremendous levels of emotional and physical stress. Hospitals are trying to help personnel cope with work-related pressure. The aim of this study was to assess HCWs' awareness and utilization of counseling and support services during the pandemic, HCWs' unmet counseling and support needs, and the type and content of these services. A cross-sectional online survey was conducted from January to June 2021 through the German national research organization Network University Medicine (NUM). All participating hospitals (6 in total) were asked to inform their employees about the study. A total of 1,495 HCWs were included in the analysis. Of these, 42.8% (n = 637) were frontline HCWs (who had contact with COVID-19 patients), 23.1% (n = 344) were second-line HCWs (who only had contact with non-COVID-19 patients) and 34.1% (n = 508) had no contact with any patients. Participating hospitals offer various counseling and support services for their staff. The percentage of respondents who were unaware of available counseling and support services ranged from 5.0 to 42.0%. Depending on the type of counseling and support services, 23.0-53.6% of the respondents indicated that counseling and support services were provided but not used, while 1.7-11.6% indicated that, despite the need for them, such services were not available. HCWs' overall satisfaction with the provided counseling and support services and their unmet support needs differed by patient contact: Frontline HCWs reported more unmet needs for counseling and support than second-line HCWs, while second-line HCWs reported more unmet needs than HCWs without patient contact. The results indicate that hospitals should make more efforts to inform HCWs about available counseling and support services. Hospitals could also create networks where HCWs could share information about the type and content of services and their experiences with various counseling and support services. These steps would enable hospitals to respond more quickly and effectively to the problems facing HCWs during pandemics.

Evaluating the impact of the metastatic spinal cord compression coordinator in a regional cancer network: a prospective, non- randomized pilot study.

Extradural metastatic spinal cord compression (MSCC) is a debilitating and potentially irreversible complication of cancer. Delay in treatment could lead to irreversible neurological damage, adverse quality of life and a burden on health care resources. Lack of effective communication between teams has been identified as one of the reasons for delay in treatment. The MSCC coordinator (often a nurse, radiotherapy radiographer or a doctor) is responsible for coordinating the diagnosis and management of patients with MSCC. The role has been shown to streamline service, ensure timely decision-making and improved survival outcomes. However, available data are anecdotal or from limited series presented as abstracts in conferences. In this study, we assessed the impact (time to treatment) of the newly introduced role on the treatment pathway compared to similar period in the preceding year. This was a multi-centre, prospective, pilot study carried out in Kent, UK between 1st April to 30th June 2021. Patients were considered eligible if they had MRI-confirmed cauda equina or cord compression. The data prospectively collected include: (I) time from diagnostic imaging to radiotherapy treatment; (II) number of referrals to hospital palliative care (HPC), occupational/physiotherapy (OPH) and community hospice referrals (CHP). A comparative retrospective data for (I) was collected for the same time period in the preceding year. The study outcome assessed was reduction in time from radiological diagnosis of MSCC to receiving radiotherapy. Fifty-eight patients in 2020 and 24 patients in 2021 were included in the dataset. The MSCC coordinator role (introduced in 2021) led to reduction in the time from imaging to treatment (P=0.045). Compared to 2020, there was a shorter mean/median time to treatment, seeing more patients being treated within 24 hours. All hospitals except East Kent Hospitals saw more patients being treated within 24 hours. 7 referrals each made to HPC, OPH and CHP respectively. Introduction of MSCC coordinator role led to improved time from imaging to radiotherapy treatment. The new service led to engagement with rehabilitative and palliative services. Future work should be done to assess the long-term impact of this role on utilization of support services and patient recovery.