Identification of Key Factors for Optimized Health Care Services: Protocol for a Multiphase Study of the Dubai Vaccination Campaign.

BACKGROUND: Mass vaccination of the global population against the novel COVID-19 outbreak posed multiple challenges, including effectively administering millions of doses in a short period of time while ensuring public safety and accessibility. The government of Dubai launched a mass campaign in December 2020 to vaccinate all its citizens and residents, targeting the population aged >18 years against COVID-19. The vaccination campaign involved a transformation of multiple commercial spaces into mass vaccination centers across the city of Dubai, the largest of which was the Dubai One Central (DOC) vaccination center. It was operational between January 17, 2021, and 27 January 27, 2022. OBJECTIVE: The multiphase research study aims to empirically explore the opinions of multiple health care stakeholders, elicit the key success factors that can influence the effective delivery of emergency health care services such as a COVID-19 mass vaccination center, and explore how these factors relate to one another. METHODS: To understand more about the operations of the DOC vaccination center, the study follows a multiphase design divided into 2 phases. The study is being conducted by the Institute for Excellence in Health Professions Education at Mohammed Bin Rashid University of Medicine and Health Sciences between December 2021 and January 2023. To elicit the key success factors that contributed to the vaccination campaign administered at DOC, the research team conducted 30 semistructured interviews (SSIs) with a sample of staff and volunteers who worked at the DOC vaccination center. Stratified random sampling was used to select the participants, and the interview cohort included representatives from the management team, team leaders, the administration and registration team, vaccinators, and volunteers. A total of 103 people were invited to take part in the research study, and 30 agreed to participate in the SSIs. To validate the participation of various stakeholders, phase 2 will analytically investigate one's subjectivity through Q-methodology and empirically investigate the opinions obtained from the research participants during phase 1. RESULTS: As of July 2022, 30 SSIs were conducted with the research participants. CONCLUSIONS: The study will provide a comprehensive 2-phase approach to obtaining the key success factors that can influence the delivery of high-quality health care services such as emergency services launched during a global pandemic. The study's findings will be translated into key factors that could support designing future health care services utilizing evidence-based practice. In line with future plans, a study will use data, collected through the DOC vaccination center, to develop a simulation model outlining the process of the customer journey and center workflow. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42278.

Attributes and Organizational Factors that Enabled Innovation in Health Care Service Delivery during the COVID-19 Pandemic - Case Studies from Brazil, Canada and Japan.

Innovation by health service organizations can enable adaptation to and transformation of challenges caused by health shocks. Drawing on results from case studies in Brazil, Canada, and Japan, this study looked at innovations the study hospitals introduced in response to challenges caused by COVID-19 to identify: 1) attributes of the innovations that make them conducive to adoption; and 2) organizational factors that facilitate the creation and implementation of innovative health care approaches during health system shocks. Qualitative information was gathered using key informant interviews, participatory observations at the study hospitals and a review of relevant documentation. A thematic approach was used for analysis, and a cross-country comparison framework was prepared to synthesize findings from the case studies in the three countries. In response to the disruptions caused by COVID-19, the study hospitals undertook innovative changes in services, processes, organizational structures, and operational policy. The driving force behind the innovations was the need and urgency generated by the unprecedented nature of the pandemic. With COVID-19, if an innovation met the perceived needs of hospitals and provided an operational advantage, some level of complexity in the implementation appeared to be acceptable. The study findings suggest that for hospitals to create and implement innovations in response to health shocks, they need to: have adaptive and flexible organizational structures; build and maintain functioning communication systems; have committed leadership; ensure all staff share an understanding of hospital organizational and professional missions; and establish social networks that facilitate the creation and implementation of new ideas.

The Usability of Homelab, a Digital Self-service at a Dutch General Practice, for Diagnostic Tests: Pilot Study With a Questionnaire.

BACKGROUND: eHealth potentially can make health care more accessible and efficient and help reduce the workload in primary health care. Homelab is an eHealth tool implemented in a general practice environment, and it offers relatively simple laboratory diagnostic tests without the referral of the general practitioner. After logging in this eHealth tool, patients select and order a diagnostic test based on their symptoms. The test results are presented online to the general practitioner and the patient. OBJECTIVE: This study aims to evaluate the use, usability, and user characteristics of Homelab. Further, it aims to evaluate whether Homelab replaces an appointment with the general practitioner. METHODS: Homelab has been implemented since May 2021 as a pilot in a Dutch general practice. The number of requests and the ordered diagnostic packages are monitored. After using Homelab, patients are invited to complete a short questionnaire. The questionnaire contains demographic questions and assesses usability using the System Usability Scale (10 items). In addition, questions about requesting an appointment with the general practitioner without Homelab are included. All data were anonymous. RESULTS: The questionnaire was filled by 74 individual patients. The mean age of the patients was 40.33 (SD 12.11) years, and half of them were females (39/74, 53%). The majority of the patients were highly educated (56/74, 76%) and employed (53/74, 72%). Approximately 81% (60/74) of the patients reported that they would use Homelab again in the future and 66% (49/74) reported that they would have gone to the general practitioner if they had not used Homelab. The usability of Homelab was perceived higher by the younger age group (mean 73.96, SD 14.74) than by the older age group (mean 61.59, SD 14.37). In total, 106 test packages were ordered over 1 year, and the most requested diagnostic package was "Am I still healthy? I want to do my annual health checkup." Homelab was used the most during the months of the COVID-19 lockdown. CONCLUSIONS: The use of Homelab, a digital self-service for ordering diagnostic tests, was monitored in this study, and its usability was perceived as above average. Our findings showed that patients are willing to use Homelab in the future and they would use it most of the time as a replacement for regular consultations. Homelab offers opportunities for more accessible and efficient health care for both the patient and the general practitioner.

How Hospitals Overcame Disruptions in the Early Stages of the COVID-19 Pandemic: A Case Study from Tokyo, Japan.

The COVID-19 pandemic has caused serious disruptions to health systems across the world. While the pandemic has not ended, it is important to better understand the resilience of health systems by looking at the response to COVID-19 by hospitals and hospital staff. Part of a multi-country study, this study looks at the first and second waves of the pandemic in Japan and examines disruptions experienced by hospitals because of COVID-19 and the processes through which they overcame those disruptions. A holistic multiple case study design was employed, and two public hospitals were selected for the study. A total of 57 interviews were undertaken with purposively selected participants. A thematic approach was used in the analysis. The study found that in the early stages of the pandemic, faced with a previously unknown infectious disease, to facilitate the delivery of care to COVID-19 patients while also providing limited non-COVID-19 health care services, the case study hospitals undertook absorptive, adaptive, and transformative actions in the areas of hospital governance, human resources, nosocomial infection control, space and infrastructure management, and management of supplies. The process of overcoming the disruptions caused by the pandemic was complex, and the solution to one issue often caused other problems. To inform preparations for future health shocks and promote resilience, it is imperative to further investigate both organizational and broader health system factors that build absorptive, adaptive, and transformative capacity in hospitals.

Comparison of health care systems in Poland and Great Britain by Poles staying temporarily in Great Britain prior to the COVID pandemic.

INTRODUCTION: Poland's accession to the European Union intensified migration for work purposes. One of the most popular destinations for emigration was Great Britain, which allocates more money to health protection than Poland, where there is a widespread belief that the quality of public health care is poor. However, more negative opinions were expressed by migrants about health care in Great Britain. OBJECTIVE: The aim of the study was to compare and assess the quality of health services in Poland and Great Britain prior to the SARS COVID-19 pandemic. MATERIAL AND METHODS: The study was conducted in the form of a questionnaire addressed to Poles who stay or stayed in the territory of Great Britain and used services provided by both Polish and British medical entities. 1,625 people took part in the study: 1,402 women (86.28%) and 223 men (13.72%). The survey contained 30 questions, of which statistically significant results were obtained in 5 of them. RESULTS: There was a statistically significant difference in the average assessments of health services in Poland and Great Britain. The availability of primary health care services and specialist services, other than gynaecology, in Poland was rated higher. In addition, the quality and costs of treatment received a much higher average score in the evaluation of Polish health care compared to the British system. CONCLUSIONS: Although the amount of financial outlays and statistical data should suggest the advantage of the British health care system, the respondents assessed the services provided in Poland being better.

The Factors Associated With Telehealth Use and Avoidance During the COVID-19 Pandemic: Longitudinal Survey.

BACKGROUND: Social distancing requirements due to the COVID-19 pandemic saw a rapid increase in the delivery of telehealth consultations as an alternative to face-to-face health care services. OBJECTIVE: The aims of this study were to assess the use and acceptability of telehealth during the early stages of the pandemic and identify factors associated with telehealth avoidance during this period. METHODS: Data were obtained from waves 4 and 7 of a longitudinal survey designed to assess the impact of the COVID-19 pandemic on the health and behavior of a representative sample of Australian adults. Participants reported on their use or avoidance of telehealth during the assessment period, as well as the mode of telehealth used and acceptability. RESULTS: Approximately 30% of participants reported using telehealth during the assessment periods, with the most common telehealth modality being the telephone. Acceptance of telehealth was generally high and was higher among those who used telehealth compared with those who did not. Approximately 18% of participants reported avoiding health care due to telehealth. Across assessment waves, avoidance was associated with younger age, speaking a language other than or in addition to English, having a current medical diagnosis, and lower levels of telehealth acceptability. CONCLUSIONS: While most participants in this study were accepting of telehealth services, there remain barriers to use, especially among those from particular sociodemographic groups. At a population level, avoidance of health services in nearly one in five adults may have considerable long-term impacts on morbidity and potentially mortality. Targeted efforts to promote engagement with telehealth services are critical if these adverse outcomes are to be avoided, particularly during periods when access to face-to-face services may be limited.

Digital Literacy-Based User Experience Design for Medication-Allergy Patients Care

Digital literacy is not based solely on an understanding of technology, but is highly influenced by social and cultural context. This study focused on developing mobile applications for medication allergy care for respiratory-related patients in daily life, which is based on inclusiveness and digital literacy. With COVID-19, there are growing needs to share the role of primary care hospitals, with, for example GPs, and self-care symptom records applications, in order to supplement the saturated medical service of general hospitals. The mobile application of ‘medication-allergy record for respiratory-related patients’ which is developed in this study considers cultural digital literacy and provides the solutions to the local people’s needs. For these objectives this study has conducted field research and analyzed the influential factors and needs in digital interaction, by interviewing 120 outpatients of respiratory and allergic internal medicine department in general hospital in Cheongju. Based on this, the direction of the mobile application has developed new information architecture and relevant wire-frames. This study will contribute to the future direction of non-face communication in health-care service by suggesting a self-data-producing digital health care service by bridging the personal culture and user-centered technology. © Springer Nature Switzerland AG 2021.

Building the Nigerian Palliative Care Workforce: An Interdisciplinary Distance Learning Training Program.

Background: Education and capacity building in palliative care are greatly needed in Nigeria. Currently, two institutions integrate palliative care into the undergraduate medical curriculum and no post graduate training exists. A team from the University of Lagos in Nigeria and Northwestern University in the US collaborated to design, implement, and evaluate a 12-hour virtual palliative care training program for Nigerian health professionals. Objective: This study investigated the impact of the first session of the training program on healthcare professionals' knowledge, skills, attitudes, and confidence in palliative care. Methods: The Education in Palliative and End-of-Life (EPEC) curriculum and the Kenya Hospices and Palliative Care Association (KEHPCA) curriculum were used as foundations for the program and adapted for the Nigerian context. Delivered online, the training focused on goals of palliative care, whole patient assessment, communication skills, pain management, psychosocial issues, palliative care in COVID, oncology, and HIV. A mixed-methods evaluation based on Kirkpatrick's evaluation framework was used and data were gathered from surveys and focus groups. Findings: Thirty-five health professionals completed the training. The training had a positive impact on knowledge, skills, and attitudes. Confidence in providing end-of-life care increased from 27.3% to 92.9% while confidence in prescribing medication to relieve symptoms at the end of life increased from 42.9% to 92.0%. Performance on multiple-choice knowledge tests increased by 10% (p < 0.01). All participants stated that they would recommend the program to a peer while 96.4% reported the program was relevant to the Nigerian context. Qualitative analysis suggested that the training would help participants provide more holistic care for patients, communicate better, and change how they interacted with families. Topics to be addressed in future training were identified. Conclusions: This virtual training can be an important element in palliative care capacity building in Nigeria and represents a model for global health collaboration.

Health literacy and related behaviour among pregnant women with obesity: a qualitative interpretive description study.

BACKGROUND: Obesity in pregnant women is increasing worldwide, affecting the health of both mother and baby. Obesity may be associated with inadequate health literacy, a central competence when navigating antenatal health information and services. This study explores women's health literacy by examining their knowledge, motivation and skills to access, understand and evaluate health information and the related behaviour among a sample of pregnant women with a prepregnant body mass index (BMI) > 25 kg/m2. METHODS: An inductive, qualitative study using an interpretive description methodology. Data was collected through ten semi-structured interviews with pregnant women with a prepregnancy BMI > 25 kg/m2 attending antenatal care at the midwifery clinic at Aarhus University Hospital in the Central Denmark Region. RESULTS: Pregnant women with obesity understand general health information provided by health professionals, but translating this knowledge into specific healthy behaviours presents a challenge. Although difficulties navigating booking systems and available digital services contribute to this problem, apps can help facilitate navigation. However, successful navigation may depend on adequate e-health literacy. Conflicting information from health professionals, social media and families also present a challenge for pregnant women, requiring a broad skillset for critical evaluation and resolution. CONCLUSIONS: Adequate health literacy is necessary for pregnant women receiving antenatal care to (i) translate general health information into personalised healthy behaviour, (ii) access and navigate complex and digitalised systems, and (iii) critically evaluate conflicting information. Person-centred differentiation in the organisation of antenatal care may benefit vulnerable pregnant women with inadequate health literacy. TRIAL REGISTRATION: The study was registered cf. General Data Protection Regulation, Aarhus University Journal number 2016-051-000001, serial number 1934.

Pandemic-Triggered Adoption of Telehealth in Underserved Communities: Descriptive Study of Pre- and Postshutdown Trends.

BACKGROUND: The adoption of telehealth services has been a challenge in rural communities. The reasons for the slow adoption of such technology-driven services have been attributed to social norms, health care policies, and a lack of infrastructure to support the delivery of services. However, the COVID-19 pandemic-related shutdown of in-person health care services resulted in the usage of telehealth services as a necessity rather than a choice. The pandemic also fast-tracked some needed legislation to allow medical cost reimbursement for remote examination and health care services. As services return to normalcy, it is important to examine whether the usage of telehealth services during the period of a shutdown has changed any of the trends in the acceptance of telehealth as a reliable alternative to traditional in-person health care services. OBJECTIVE: Our aim was to explore whether the temporary shift to telehealth services has changed the attitudes toward the usage of technology-enabled health services in rural communities. METHODS: We examined the Medicaid reimbursement data for the state of Alabama from March 2019 through June 2021. Selecting the telehealth service codes, we explored the adoption rates in 3 phases of the COVID-19 shutdown: prepandemic, pandemic before the rollout of mass vaccination, and pandemic after the rollout of mass vaccination. RESULTS: The trend in telemedicine claims had an opposite pattern to that in nontelemedicine claims across the 3 periods. The distribution of various characteristics of patients who used telemedicine (age group, gender, race, level of rurality, and service provider type) was different across the 3 periods. Claims related to behavior and mental health had the highest rates of telemedicine usage after the onset of the pandemic. The rate of telemedicine usage remained at a high level after the rollout of mass vaccination. CONCLUSIONS: The current trends indicate that adoption of telehealth services is likely to increase postpandemic and that the consumers (patients), service providers, health care establishments, insurance companies, and state and local policies have changed their attitudes toward telehealth. An increase in the use of telehealth could help local and federal governments address the shortage of health care facilities and service providers in underserved communities, and patients can get the much-needed care in a timely and effective manner.

Mental Health Presentations Across Health Care Settings During the First 9 Months of the COVID-19 Pandemic in England: Retrospective Observational Study.

BACKGROUND: The COVID-19 pandemic has resulted in an unprecedented impact on the day-to-day lives of people, with several features potentially adversely affecting mental health. There is growing evidence of the size of the impact of COVID-19 on mental health, but much of this is from ongoing population surveys using validated mental health scores. OBJECTIVE: This study investigated the impact of the pandemic and control measures on mental health conditions presenting to a spectrum of national health care services monitored using real-time syndromic surveillance in England. METHODS: We conducted a retrospective observational descriptive study of mental health presentations (those calling the national medical helpline, National Health Service [NHS] 111; consulting general practitioners [GPs] in and out-of-hours; calling ambulance services; and attending emergency departments) from January 1, 2019, to September 30, 2020. Estimates for the impact of lockdown measures were provided using an interrupted time series analysis. RESULTS: Mental health presentations showed a marked decrease during the early stages of the pandemic. Postlockdown, attendances for mental health conditions reached higher than prepandemic levels across most systems-a rise of 10% compared to that expected for NHS 111 and 21% for GP out-of-hours service-while the number of consultations to GP in-hours service was 13% lower compared to the same time previous year. Increases were observed in calls to NHS 111 for sleep problems. CONCLUSIONS: These analyses showed marked changes in the health care attendances and prescribing for common mental health conditions across a spectrum of health care provision, with some of these changes persisting. The reasons for such changes are likely to be complex and multifactorial. The impact of the pandemic on mental health may not be fully understood for some time, and therefore, these syndromic indicators should continue to be monitored.

Impact of COVID-19 on animal health care services in Karnataka

The study assessed the impact of COVID-19 associated lockdowns on animal health services, coping practices, and financial loss to livestock farmers in Karnataka. A cross-sectional survey among 170 livestock farmers and 24 field veterinarians working in the study jurisdiction were interviewed using a structured questionnaire. Descriptive statistics and repeated ANOVA were employed to asses the impact of COVID-19 lockdown. The results revealed a significant difference in the number of cases attended at different periods of lockdowns and among the veterinarians, with a decline in the number of cases attended across the species of pets (54.9%) followed by goats (35.3%), sheep (29.1%), cattle (25.5%) and buffalo (21.6%) during the lockdown. The mode of veterinarian contact through phone calls (80%) and WhatsApp (46.7%) increased significantly and veterinarian visits decreased by 27.3% and farmers' visits to veterinary hospitals decreased by 61.9% during lockdown. The livestock farmers' welfare schemes were ed by lockdown and the vaccine administration against diseases like PPR, ET, and HS per veterinarian declined in sheep and goats. However, targeted vaccination against FMD in cattle was found achieved. The COVID-19 and associated lockdown affected the livestock farmers in multiple dimensions. Hence, to cope with lockdown-like situations, it is recommended to engage trained personnel, practitioners, and Non-Governmental Organisations (NGOs) associated with animal health care services to provide uninterrupted health care services to livestock farmers.

Exploring Public Perceptions of Dental Care Affordability in the United States: Mixed Method Analysis via Twitter.

BACKGROUND: Dental care expenses are reported to present higher financial barriers than any other type of health care service in the United States. Social media platforms such as Twitter have become a source of public health communication and surveillance. Previous studies have demonstrated the usefulness of Twitter in exploring public opinion on aspects of dental care. To date, no studies have leveraged Twitter to examine public sentiments regarding dental care affordability in the United States. OBJECTIVE: The aim of this study is to understand public perceptions of dental care affordability in the United States on the social media site, Twitter. METHODS: Tweets posted between September 1, 2017, and September 30, 2021, were collected using the Snscrape application. Query terms were selected a priori to represent dentistry and financial aspects associated with dental treatment. Data were analyzed qualitatively using both deductive and inductive approaches. In total, 8% (440/5500) of all included tweets were coded to identify prominent themes and subthemes. The entire sample of included tweets were then independently coded into thematic categories. Quantitative data analyses included geographic distribution of tweets by state, volume analysis of tweets over time, and distribution of tweets by content theme. RESULTS: A final sample of 5314 tweets were included in the study. Thematic analysis identified the following prominent themes: (1) general sentiments (1614 tweets, 30.4%); (2) delaying or forgoing dental care (1190 tweets, 22.4%); (3) payment strategies (1019 tweets, 19.2%); (4) insurance (767 tweets, 14.4%); and (5) policy statements (724 tweets, 13.6%). Geographic distributions of the tweets established California, Texas, Florida, and New York as the states with the most tweets. Qualitative analysis revealed barriers faced by individuals to accessing dental care, strategies taken to cope with dental pain, and public perceptions on aspects of dental care policy. The volume and thematic trends of the tweets corresponded to relevant societal events, including the COVID-19 pandemic and debates on health care policy resulting from the election of President Joseph R. Biden. CONCLUSIONS: The findings illustrate the real-time sentiment of social media users toward the cost of dental treatment and suggest shortcomings in funding that may be representative of greater systemic failures in the provision of dental care. Thus, this study provides insights for policy makers and dental professionals who strive to increase access to dental care.

The Essential Network (TEN): Protocol for an Implementation Study of a Digital-First Mental Health Solution for Australian Health Care Workers During COVID-19.

BACKGROUND: The COVID-19 pandemic has placed health care workers (HCWs) under severe stress, compounded by barriers to seeking mental health support among HCWs. The Essential Network (TEN) is a blend of digital and person-to-person (blended care) mental health support services for HCWs, funded by the Australian Federal Department of Health as part of their national COVID-19 response strategy. TEN is designed as both a preventative measure and treatment for common mental health problems faced by HCWs. New blended services need to demonstrate improvements in mental health symptoms and test acceptability in their target audience, as well as review implementation strategies to improve engagement. OBJECTIVE: The primary objective of this implementation study is to design and test an implementation strategy to improve uptake of TEN. The secondary objectives are examining the acceptability of TEN among HCWs, changes in mental health outcomes associated with the use of TEN, and reductions in mental health stigma among HCWs following the use of TEN. METHODS: The implementation study contains 3 components: (1) a consultation study with up to 39 stakeholders or researchers with implementation experience to design an implementation strategy, (1) a longitudinal observational study of at least 105 HCWs to examine the acceptability of TEN and the effectiveness of TEN at 1 and 6 months in improving mental health (as assessed by the Distress Questionnaire [DQ-5], Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder [GAD-7], Oldenburg Burnout Inventory [OBI-16], and Work and Social Adjustment Scale [WSAS]) and reducing mental health stigma (the Endorsed and Anticipated Stigma Inventory [EASI]), and (3) an implementation study where TEN service uptake analytics will be examined for 3 months before and after the introduction of the implementation strategy. RESULTS: The implementation strategy, designed with input from the consultation and observational studies, is expected to lead to an increased number of unique visits to the TEN website in the 3 months following the introduction of the implementation strategy. The observational study is expected to observe high service acceptability. Moderate improvements to general mental health (DQ-5, WSAS) and a reduction in workplace- and treatment-related mental health stigma (EASI) between the baseline and 1-month time points are expected. CONCLUSIONS: TEN is a first-of-a-kind blended mental health service available to Australian HCWs. The results of this project have the potential to inform the implementation and development of blended care mental health services, as well as how such services can be effectively implemented during a crisis. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34601.

How the Norwegian population was affected by non-pharmaceutical interventions during the first six weeks of the COVID-19 lockdown.

AIMS: The aim of this study was to examine how the Norwegian general adult population was affected by non-pharmaceutical interventions during the first six weeks of the COVID-19 lockdown. We assessed quarantine, symptoms, social distancing, home office/school, work status, social contact and health-care contact through digital access and knowledge. METHODS: A cross-sectional survey was performed of 29,535 adults (aged 18-99) in Norway after six weeks of non-pharmaceutical interventions in March/April 2020. RESULTS: Most participants found the non-pharmaceutical interventions to be manageable, with 20% of all adults and 30% of those aged <30 regarding them as acceptable only to some or a limited degree. Sixteen per cent had been quarantined, 6% had experienced symptoms that could be linked to COVID-19 and 84% practiced social distancing. Eleven per cent reported changes in the use of health and social services. Three-quarters (75%) of those who had mental health or physiotherapy sessions at least monthly before the pandemic reported a reduction in their use of these services. A substantial reduction was also seen for home nursing, hospital services and dentists compared to usage before the non-pharmaceutical interventions. Immigrants were more likely to experience a reduction in follow-up from psychologists and physiotherapy. With regard to the use of general practitioners, the proportions reporting an increase and a reduction were relatively equal. CONCLUSIONS: The non-pharmaceutical interventions were perceived as manageable by the majority of the adult general population in Norway at the beginning of the COVID-19 pandemic. A substantial proportion of adults <30 years old experienced difficulties with social distancing, and those >70 years old lacked the digital tools and knowledge. Further, immigrant access to health services needs monitoring and future attention.

Associations between accessibility to health care service, social support, and Korean Americans' mental health status amid the COVID-19 pandemic.

BACKGROUND: While previous studies have examined the relationships between social support and health care accessibility among ethnic minority populations, studies on Korean Americans remain scarce. Therefore, this study aims to assess the relationship between Korean Americans' mental health, accessibility to health care, and how they perceive the level of social support during the COVID-19 pandemic. METHOD/RESULT: We distributed online surveys to Korean Americans from May 24, 2020, to June 14, 2020, generating 790 responses from participants residing in 42 states. Binary Logistic and Ordinary Least Square regression analyses revealed that poor mental health was associated with language barriers inhibiting Korean Americans' access to COVID-19-related information. Their perceived social support from family members and close friends was positively associated with mental health. CONCLUSION: Our findings recommend that equipping community health care services with translators or interpreters is necessary. Additionally, health practitioners and staff should be trained to utilize telehealth tools to effectively treat individuals with mental health problems. American policymakers and health care professionals need to understand and address the unique hardships Korean Americans experience amid COVID-19.

Factors Affecting Breastfeeding Practices under Lockdown during the COVID-19 Pandemic in Thailand: A Cross-Sectional Survey.

A COVID-19 lockdown and restrictive order has had a large impact on the lives of people. This cross-sectional study was conducted to identify factors affecting breastfeeding among mothers living in Thailand during the lockdown. Data were collected from 903 mothers with infants ages 0-12 months from 17 July 2020 to 17 October 2020 after the first nationwide COVID-19 lockdown period by an online platform and interview questionnaire survey. Multivariable logistic regression analysis was used to investigate the association between the effect of lockdown and breastfeeding practices with potential confounder adjustment including maternal age, ethnicity, newborn age <6 months, family income below $16,130 per annum, education below undergraduate level, and working status. Mothers changed breastfeeding practices in this period (n = 39, 4.32%) including having changed from exclusive breastfeeding to combined breastfeeding with formula milk (n = 22, 2.44%), and having reduced the frequency when compared to before the pandemic (n = 13, 1.44%). The associated factors of changing breastfeeding practices were "contact with healthcare services" (aOR = 0.46, 95% CI 0.22 to 0.96, p = 0.04), "infant feeding support from health personnel" (aOR = 0.39, 95% CI 0.16 to 1.94, p = 0.035), and "lack family support and help with feeding your baby after lockdown" (aOR = 7.04, 95% CI 1.92 to 25.84, p = 0.003). In conclusion, this study showed a slight decrease in breastfeeding in the sampled mothers during the COVID-19 lockdown in Thailand. A long-term national surveillance system for maintenance of breastfeeding should be established. Health care service interventions and additional information are needed to support mothers and families for breastfeeding during pandemics.

Managing COVID-19 Crisis using C3HIS Ontology.

The paper aims to present the C3HIS Ontology project, a web based solution for Covid-19 Crisis Health Care Information System. In the health care services, employee skills are a major resource and an essential part of everyday practice and a requirement for all health professions. We aim to prove how using individual profiles based on competencies can make a difference between life and death in times. As the performance assessment is driven by actors competencies we have to put human actors in the core of quality processes of health care services management in COVID-19 crisis.

Patients with inflammatory bowel disease on immunosuppressive drugs: perspectives' on COVID-19 and health care service during the pandemic.

BACKGROUND AND AIMS: Patients with inflammatory bowel diseases (IBD) have experienced changes to the routine management because of the SARS-CoV-2 pandemic. The aim of this study was to examine patients with IBD's adherence to the restrictions imposed by society and the hospital, worries and concerns regarding medical treatment and clinical follow-up under the pandemic. METHODS: IBD patients (≥18 years) at the outpatient clinic at Oslo University Hospital were included and answered a self-report questionnaire including concerns regarding their disease, medical therapy and follow-up during SARS-CoV-2 pandemic. RESULTS: In total, 522 IBD patients were included, 317 Crohn's disease, 205 ulcerative colitis, 386 patients <50 years. Eighteen percent were in obligatory quarantine, and more often patients <50 years compared to patients ≥50 years. Five patients tested positive to SARS- CoV-2. A higher proportion <50 years reported worries for their medical treatment and risk of COVID -19 disease compared to those ≥50 years. Forty percent avoided family, two-thirds avoided friends, and 4% cancelled their scheduled consultation at the hospital. The hospital changed physical consultation to telephone consultation for 15% of the patients. The preferred follow-up was physical consultation. A higher proportion of the patients <50 years preferred telephone consultation compared to those ≥50 years. Four out of five IBD patients were satisfied with the information about their IBD and COVID-19. CONCLUSIONS: SARS-CoV-2 pandemic affects the daily lives for patients with IBD. It is important to develop evidence-base guidelines in follow-up and treatment, as well as patient information about COVID-19and IBD.

Applying Psychotherapeutic Principles to Bolster Resilience Among Health Care Workers During the COVID-19 Pandemic.

The COVID-19 pandemic has affected the entire globe with overwhelming speed and impact. The pandemic is both highly threatening and poorly understood, typical of deeply distressing conditions. Stress associated with uncertain recommendations from authorities, fear of illness and contagion for oneself and one's loved ones, extended periods of isolation, moral conflicts, financial instability, perception of discrimination and/or stigma, and ongoing loss and grief imperil mental health and resilience among the general population and high-risk groups. Health care workers (HCWs) face additional challenges that increase their vulnerability to distress and burnout. Bolstering resilience among HCWs can allow them to continue working with the intensity and focus their jobs require, which in turn supports the overall functioning of the health care system. Given their training in understanding wellness, distress, and psychotherapeutic treatment, mental health clinicians are well positioned to respond to this need. By studying the lessons from past and present experiences with public health emergencies and by incorporating principles from psychotherapeutic literature and training, clinicians can help facilitate an informed and effective response. The goal of this article is to discuss the development of a resilience coaching model that is rooted in principles from psychotherapeutic literature and practice to support psychological well-being among hospital-based HCWs. This model, developed to support the authors' health care colleagues working in a Toronto hospital, is generalizable, can be adapted for use by any mental health clinician, and makes explicit how previous training in psychotherapy may be applied to coaching and supporting frontline HCWs.