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1.
BMJ Open ; 11(7), 2021.
Article in English | ProQuest Central | ID: covidwho-1843093

ABSTRACT

ObjectiveTo test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity.DesignPopulation-based cross-sectional study.SettingIceland.ParticipantsA total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19.Main outcome measuresSymptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD;modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities.ResultsCompared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%;adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%;aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%;aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%;aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%;aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%;aRR 2.72, 95% CI 1.67 to 4.44).ConclusionsSevere disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.

2.
American Journal of Public Health ; 112(5):697-699, 2022.
Article in English | ProQuest Central | ID: covidwho-1843083

ABSTRACT

ommunity health workers (CHWs) have a long, rich global history of extending essential health services and helping address social determinants of health for underserved populations.1 The 1978 Declaration of Alma-Ata, which called for the achievement of "health for all," explicitly defined a role for CHWs as an integral member of primary health care teams.2 In the United States, CHWs have historically been patient health educators and advocates, particularly for patients who have limited health knowledge or whose first language is not English. Despite these efforts, the CHW workforce in the United States has been underrecognized and underutilized, and many have called for policy change to better integrate CHWs into the US health system.3,4 CHWs have been largely neglected in health workforce planning, with existing programs often led by multiple actors without coordination, with fragmented or diseasespecific foci, unclear links to the health system, and unclear identities because of wide-rangingjob titles.2 Small programs and demonstration projects have shown the efficacy and promise of CHWs to improve population health outcomes,5,6 but monitoring and evaluation systems for large-scale CHW programs have been weak, and evidence of their real-world effectiveness and cost-effectiveness has been limited. In many communities, CHWs have been instrumental in COVID-19 public health messaging and communication, contact tracing and monitoring in medically underserved communities, navigation to vaccine and testing appointments, and even in conducting rapid antigen testing with the proper training and personal protective equipment. Leveraging this current momentum and unique window of opportunity to strengthen and expand this critical workforce will require evidence-based practices8,11,12 for effective recruitment, training and certification, retention, evaluation, supervision, reimbursement, recognition, and remuneration of CHWs to ensure success and sustainability long beyond the COVID-19 pandemic. >4JPH CORRESPONDENCE Correspondence should be sent to Natalia M. Rodriguez, PhD, MPH, Department of Public Health, College of Health and Human Sciences, Purdue University, Matthews Hall 218, 812 W State St, West Lafayette, IN 47907 (e-mail: natalia@purdue.edu).

3.
BMJ Open ; 11(9), 2021.
Article in English | ProQuest Central | ID: covidwho-1842958

ABSTRACT

ObjectivesTo assess primary care physicians’ satisfaction towards COVID-19 pandemic management in Qatar and to identify the associated factors with their satisfaction.DesignA cross-sectional web-based survey conducted from 1 June to 30 July 2020.SettingAll the 27 public primary healthcare centres in Qatar.Participants294 primary care physicians working in the publicly run primary healthcare corporation in Qatar.Primary outcome measuresOverall satisfaction towards COVID-19 management in Qatar and satisfaction towards each aspect of this management including COVID-19 clinical practice guidelines, psychological support, team dynamics, work safety as well as institutional and governmental regulations.Results294 primary care physicians participated in the survey with a response rate of 65%. Overall satisfaction of physicians towards COVID-19 19 management at Primary Health Care Corporation was 77%. The highest satisfaction was towards institutional and governmental support while it was the lowest towards the corporation case definition and management of COVID-19 guidelines. Female physicians were less satisfied with psychological support in comparison to males (64.1% and 51% respectively, p=0.049). Overall satisfaction towards case definition and management of COVID-19 guidelines were strongly correlated with their clarity, updating these guidelines in due time and applicability of the guidelines (r=0.759 P<0.001;r=0.701 P<0.001;r=0.698 P<0.001) respectively, while satisfaction towards work safety was strongly correlated with availability and quality of Personal Protective Equipment provided (r=0.83 P<0.001 and r=0.811 P<0.001 respectively).ConclusionMost primary care physicians in Qatar who responded to the survey were satisfied with the COVID-19 guidelines developed rapidly in response to this pandemic. Availability and quality of PPE were a particular concern. The clinicians who were less satisfied were younger and female.

4.
BMJ Open ; 11(8), 2021.
Article in English | ProQuest Central | ID: covidwho-1842917

ABSTRACT

ObjectivesWe explore the importance of SARS-CoV-2 sentinel surveillance testing in primary care during a regional COVID-19 outbreak in Austria.DesignProspective cohort study.SettingA single sentinel practice serving 22 829 people in the ski-resort of Schladming-Dachstein.ParticipantsAll 73 patients presenting with mild-to-moderate flu-like symptoms between 24 February and 03 April, 2020.InterventionNasopharyngeal sampling to detect SARS-CoV-2 using real-time reverse transcriptase-quantitative PCR (RT-qPCR).Outcome measuresWe compared RT-qPCR at presentation with confirmed antibody status. We split the outbreak in two parts, by halving the period from the first to the last case, to characterise three cohorts of patients with confirmed infection: early acute (RT-qPCR reactive) in the first half;and late acute (reactive) and late convalescent (non-reactive) in the second half. For each cohort, we report the number of cases detected, the accuracy of RT-qPCR, the duration and variety of symptoms, and the number of viral clades present.ResultsTwenty-two patients were diagnosed with COVID-19 (eight early acute, seven late acute and seven late convalescent), 44 patients tested SARS-CoV-2 negative and 7 were excluded. The sensitivity of RT-qPCR was 100% among all acute cases, dropping to 68.1% when including convalescent. Test specificity was 100%. Mean duration of symptoms for each group were 2 days (range 1–4) among early acute, 4.4 days (1–7) among late acute and 8 days (2–12) among late convalescent. Confirmed infection was associated with loss of taste. Acute infection was associated with loss of taste, nausea/vomiting, breathlessness, sore throat and myalgia;but not anosmia, fever or cough. Transmission clusters of three viral clades (G, GR and L) were identified.ConclusionsRT-qPCR testing in primary care can rapidly and accurately detect SARS-CoV-2 among people with flu-like illness in a heterogeneous viral outbreak. Targeted testing in primary care can support national sentinel surveillance of COVID-19.

5.
BMJ Open ; 11(7), 2021.
Article in English | ProQuest Central | ID: covidwho-1842915

ABSTRACT

ObjectivesTo develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory.DesignRealist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation.ResultsA taxonomy was produced, including 13 categories of physical activity interventions for people with long-term conditions.Abridged realist programme theoryRoutinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources, with better coordination, will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions helps affect positive patient behaviour change. Training can improve knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy.Co-designThe programme theory informed the co-design of a prototype intervention to: improve physical literacy among practice staff;describe/develop the role of a physical activity advisor who can encourage the use of local opportunities to be more active;and provide materials to support behaviour change.ConclusionsPrevious physical activity interventions in primary care have had limited effect. This may be because they have only partially addressed factors emerging in our programme theory. The co-designed prototype intervention aims to address all elements of this emergent theory, but needs further development and consideration alongside current schemes and contexts (including implications relevant to COVID-19), and testing in a future study. The integration of realist and co-design methods strengthened this study.

6.
BMJ Open ; 11(8), 2021.
Article in English | ProQuest Central | ID: covidwho-1842848

ABSTRACT

ObjectiveThis study sought to explore the experiences of Australian primary healthcare (PHC) nurses in the use of telehealth during COVID-19. Telehealth was defined as the use of any telecommunications mode (eg, telephone and videoconferencing) to deliver healthcare.Design and settingThematic analysis of qualitative interviews undertaken in Australian PHC.ParticipantsTwenty-five PHC nurses who had participated in a national survey about their experiences during COVID-19 were recruited using purposive sampling.MethodsSemistructured telephone interviews were conducted from June to August 2020. Interviews lasted a mean of 38.5 min. They were audio-recorded and transcribed before thematic analysis was undertaken. The consolidated criteria for reporting qualitative research were followed.ResultsFour overarching themes were identified: preparedness, accessibility of telehealth, care experience and impacts on the PHC nurses’ role. Some nurses were experienced in the use of telehealth, while others indicated a lack of preparation and limited appropriate technology to support its use. Telehealth enabled patients to access care but did not support complex clinical assessment. Participants indicated that patient engagement in telehealth was dependent on access and confidence using technology, perceived safety when physically attending the practice and the value they placed on care via telehealth. Many participants expressed frustration about telehealth funding and its impact on facilitating nurses to practise to their full scope.ConclusionTelehealth has provided a means to continue PHC service delivery during COVID-19. While there are advantages to adopting this technology, considerations of the challenges and lessons from this experience are important to inform the future implementation of telehealth initiatives.

7.
Journal of Public Management & Social Policy ; 28(1/2):5-17, 2021.
Article in English | ProQuest Central | ID: covidwho-1842810

ABSTRACT

COVID-19 has exposed health care disparities long known and discussed in medical and public policy literature. While there have been many discussions regarding our "offense" - how to attack a global pandemic (vaccines, treatment algorithms, etc), there has also been a renewed interest regarding our "defense" (limiting exposure, strengthening the host) - i.e., how to protect our most vulnerable populations. In June 2020, The U.S. Health and Human Services Department announced a $40 million, three-year partnership with the Morehouse School of Medicine to focus on this topic. As described by Danie Dawes (director of Morehouse's Satcher Health Leadership Institute), this national COVID-19 resiliency network (NCRN) will focus on at-risk communities and social determinants of health. With a few policy changes this "perfect storm" (deadly virus + high exposure + overly susceptible hosts) might not have occurred, so it is imperative that we learn from mistakes of the past and act quickly so that lives may be saved. While we work on vaccines, better testing options and social distancing - our defense for the next pandemic can begin now by creating a healthier society for us all. Health equity is needed now more than ever.

8.
BMJ Open ; 11(9), 2021.
Article in English | ProQuest Central | ID: covidwho-1842797

ABSTRACT

IntroductionThe COVID-19 pandemic has transformed healthcare systems worldwide. Primary care providers have been at the forefront of the pandemic response and have needed to rapidly adjust processes and routines around service delivery. The pandemic provides a unique opportunity to understand how general practices prepare for and respond to public health emergencies. We will follow a range of general practices to characterise the changes to, and factors influencing, modifications to clinical and organisational routines within Australian general practices amidst the COVID-19 pandemic.Methods and analysisThis is a prospective case study of multiple general practices using a participatory approach for design, data collection and analysis. The study is informed by the sociological concept of routines and will be set in six general practices in Melbourne, Australia during the 2020–2021 COVID-19 pandemic. General practitioners associated with the Monash University Department of General Practice will act as investigators who will shape the project and contribute to the data collection and analysis. The data will include investigator diaries, an observation template and interviews with practice staff and investigators. Data will first be analysed by two external researchers using a constant comparative approach and then later refined at regular investigator meetings. Cross-case analysis will explain the implementation, uptake and sustainability of routine changes that followed the commencement of the pandemic.Ethics and disseminationEthics approval was granted by Monash University (23950) Human Research Ethics Committees. Practice reports will be made available to all participating practices both during the data analysis process and at the end of the study. Further dissemination will occur via publications and presentations to practice staff and medical practitioners.

9.
BMJ Open ; 11(7), 2021.
Article in English | ProQuest Central | ID: covidwho-1842606

ABSTRACT

ObjectiveTo describe primary health care (consultation characteristics and management) for patients contacting their general practitioner (GP) with a respiratory tract infection (RTI) early on in the COVID-19 pandemic in contrasting European countries, with comparison to prepandemic findings.SettingPrimary care in 16 countries (79 practices), when no routine SARS-CoV-2 testing was generally available.Design and participantsBefore (n=4376) and early in the pandemic (n=3301), patients with RTI symptoms were registered in this prospective audit study.Outcome measuresConsultation characteristics (type of contact and use of PPE) and management characteristics (clinical assessments, diagnostic testing, prescribing, advice and referral) were registered. Differences in these characteristics between countries and between pandemic and prepandemic care are described.ResultsCare for patients with RTIs rapidly switched to telephone/video consultations (10% in Armenia, 91% in Denmark), and when consultations were face-to-face, GPs used PPE during 97% (95% CI 96% to 98%) of contacts. Laboratory testing for SARS-CoV-2 in primary care patients with RTIs was rapidly implemented in Denmark (59%) and Germany (31%), while overall testing for C reactive protein decreased. The proportion of patients prescribed antibiotics varied considerably between countries (3% in Belgium, 48% in UK) and was lower during the pandemic compared with the months before, except for Greece, Poland and UK. GPs provided frequent and varied COVID-related advice and more frequently scheduled a follow-up contact (50%, 95% CI 48% to 52%). GPs reported a slightly higher degree of confidence in the likely effectiveness of their management in face-to-face (73% (very) confident, 95% CI 71% to 76%) than in virtual consultations (69%, 95% CI 67% to 71%).ConclusionsDespite between-country variation in consultation characteristics, access to SARS-CoV-2 laboratory testing and medication prescribing, GPs reported a high degree of confidence in managing their patients with RTIs in the emerging pandemic. Insight in the highly variable pandemic responses, as measured in this multicountry audit, can aid in fine-tuning national action and in coordinating a pan-European response during future pandemic threats.

10.
ZFA: Zeitschrift für Allgemeinmedizin. ; 98(5):169-177, 2022.
Article in German | Academic Search Complete | ID: covidwho-1841858

ABSTRACT

Acute cough (< 8 weeks) is a frequent complaint in family practice consultations. The most common cause are respiratory infections. The Guideline „Acute and chronic cough” of the German College of General Practitioners and Family Physicians (DEGAM) was updated in 2021 and contains recommendations for an evidence-based approach for the management of acute cough in primary care. Methods The guideline has been updated in accordance with the findings of a systematic search of the literature for international guidelines and systematic reviews. All recommendations were developed by an interdisciplinary guideline committee and agreed by formal consensus. Results History-taking, exclusion of red flags and a physical examination are the basis of diagnostic evaluation. If an acute, uncomplicated bronchitis is likely, no laboratory tests, sputum diagnostics, or chest x-rays should be performed, and antibiotics should not be administered. Evidence based strategies to avoid antibiotic therapy (delayed prescribing, shared decision making, point-of-care-tests) can be used. There is inadequate evidence for the efficacy of antitussive or expectorant drugs against acute cough. The state of the evidence for phytotherapeutic agents is heterogeneous;clinical importance is minimal. COVID-19 should currently be considered in cases of acute respiratory symptoms. If specific symptoms or red flags occur, further diagnoses in the context of acute cough such as community-acquired pneumonia, influenza disease and exacerbations of chronic respiratory diseases (bronchial asthma, COPD) should be taken into consideration. Conclusions These evidence-based recommendations are intended to reduce the use of antibiotics to treat colds and acute bronchitis, for which they are not indicated. Further clinical trials of symptomatic treatments for cough should be performed in order to extend the evidence base. (English) [ FROM AUTHOR] Akuter Husten (< 8 Wochen) ist ein häufiger Beratungsanlass in der Hausarztpraxis. Überwiegend liegen selbstlimitierende Atemwegsinfekte zugrunde. In der 2021 aktualisierten S3-Leitlinie „akuter und chronischer Husten” der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM) wurde ein evidenzbasiertes Vorgehen zum Umgang mit akutem Husten erarbeitet. Methoden Leitlinienaktualisierung mittels systematischer Literaturrecherche nach internationalen Leitlinien und systematischen Übersichtsarbeiten. Alle Empfehlungen sind interdisziplinär entwickelt und formal konsentiert. Ergebnisse Anamnese und körperliche Untersuchung führen überwiegend zur Diagnosestellung. Die akute unkomplizierte Bronchitis wird klinisch diagnostiziert;auf Laboruntersuchungen, Sputumdiagnostik und Thorax-Aufnahmen sollte verzichtet werden. Eine Antibiotikatherapie soll nicht erfolgen, dabei können evidenzbasierte Strategien zur Vermeidung nicht indizierter antibiotischer Therapien (Delayed Prescribing, Shared Decision Making, Point-of-Care-Tests) genutzt werden. Ein akuter Husten im Rahmen eines Atemwegsinfektes klingt auch ohne Therapie ab;für eine medikamentöse Linderung durch Antitussiva und Expektorantien besteht nur geringe Evidenz. Bei Phytotherapeutika ist die Gesamtstudienlage heterogen und die klinische Relevanz unklar. Bei jedem respiratorischen Infekt muss aktuell COVID-19 als Differenzialdiagnose in Betracht gezogen werden. Bei spezifischen Symptomen und Red Flags sind weitere Differenzialdiagnosen wie die ambulant erworbene Pneumonie, die Influenza-Erkrankung und Exazerbationen chronischer Atemwegsinfektionen (Asthma bronchiale, COPD) in Betracht zu ziehen. Schlussfolgerungen Die Empfehlungen sollen dazu beitragen, den nicht indizierten Antibiotikaeinsatz bei Erkältungsinfekten mit evidenzbasierten Strategien zu reduzieren. Aufgrund nicht zufriedenstellender Evidenz sind weitere kontrollierte Studien zur antitussiven Therapie erforderlich. (German) [ FROM AUTHOR] Copyright of ZFA: Zeitschrift für Allgemeinmedizin is the property of Deutscher Aerzte-Verlag GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

11.
J Telemed Telecare ; : 1357633X221094406, 2022 May 11.
Article in English | MEDLINE | ID: covidwho-1840716

ABSTRACT

INTRODUCTION: Our earlier analysis during the COVID-19 surges in 2020 showed a reduction in general practitioner (GP) in-person visits to residential aged care facilities (RACFs) and increased use of telehealth. This study assessed how sociodemographic characteristics affected telehealth utilisation. METHODS: This retrospective cohort consists of 27,980 RACF residents aged 65 years and over, identified from general practice electronic health records in Victoria and New South Wales during March 2020-August 2021. Residents' demographic characteristics, including age, sex, region, and pension status, were analysed to estimate the odds ratio (OR) and 95% confidence interval (CI) for the associations with telehealth utilisation (telephone/video vs. in-person consultations) and with video versus telephone consultations, in mixed-effects multiple level regression models. RESULTS: Of 32,330 median monthly GP consultations among 21,987 residents identified in 2020, telehealth visits accounted for 17% of GP consultations, of which 93% were telephone consults. In 2021, of 32,229 median monthly GP consultations among 22,712 residents, telehealth visits accounted for 11% of GP consultations (97% by telephone). Pension holders (OR: 1.14; 95% CI: 1.10, 1.17) and those residing in rural areas (OR: 1.72; 95% CI: 1.57, 1.90) were more likely to use telehealth. However, residents in rural areas were less likely to use video than telephone in GP consultations (OR: 0.41; 95% CI: 0.29, 0.57). Results were similar in separate analyses for each COVID surge. DISCUSSION: Telephone was primarily used in telehealth consultations among pension holders and rural residents in RACFs. Along with the limited use of video in virtual care in rural RACFs, the digital divide may imply potential healthcare disparities in socially disadvantaged patients.

12.
International Journal of Environmental Research and Public Health ; 19(9):5028, 2022.
Article in English | ProQuest Central | ID: covidwho-1837910

ABSTRACT

Background: The world faces vast health challenges, and urban residents living in high-density areas have even greater demand for healthy lifestyles. Methods: Based on the data of points of interest, a field survey, and an interview, we explored the healthy community-life circle in the downtown area of Chengdu, China from two perspectives: objective measurement and subjective perception of residents. We evaluated the coverage rate and convenience in accessing eight types of health service facilities within a 15-min walk using linear and logistics regression models to explore the degree of resident satisfaction with facilities and influencing factors. Results: Results showed significant differences in coverage rates between different districts. The overall convenience in accessing health service facilities decreased gradually from the city center to the outskirts. The social environment, the layout of health service facilities, and residents’ travel habits were related to health service facility satisfaction. Results also showed significant differences in various facilities’ accessibility satisfaction between objective measurement and residents’ perception measurement. Compared with subjective measurement, the objective measurements of accessibility for sports venues (objectively measured average minus perceived average: −1.310), sports zones (−0.740), and specialized hospitals (−1.081) were lower;those for community hospitals (0.095), clinics (1.025), and pharmacies (0.765) were higher;and facility accessibility measured by subjective perception had a more significant impact on health facility satisfaction. Pharmacies (OR: 1.932) and community hospitals (OR: 1.751) had the largest impact among the eight types of facilities. Conclusion: This study proposed to construct a healthy community-life circle with a category and hierarchy system.

13.
Pediatria de Atencion Primaria ; 24(93):e53-e60, 2022.
Article in Spanish | Scopus | ID: covidwho-1837669

ABSTRACT

Introduction: On March 11, 2020, the World Health Organization (WHO) declared a pandemic, caused by a new coronavirus SARS-CoV-2. The rapid increase in transmissions forced governments and health authorities to take measures to curb the pandemic’s rise. After the first epidemic wave and with a documented drop in the number of cases, measures were phased down and populations emerged from lockdown. At this epidemiologic point, we wished to analyse clinical pediatric activity in our health centre, in order to gain valuable insights regarding the consultation model (on-site/remote), motives for consultation and the solving potential. Material and methods: Descriptive, observational and prospective study on patients treated at the primary care pediatric consultations in a health center in the city of Madrid, during the month of June 2020. Data obtained from the AP-Madrid computerized medical record. Results: A total of 1,321 patients were treated, 34% less than in the same period of the previous year. The consultation modality carried out was onsite in 49% and remote in 51% of all patients. Telephone consultation comprised the main choice as an alternative to onsite. 20.7% of all motives for consultation were attended online. Conclusions: After the health crisis caused by COVID-19, the remote care modality has acquired prominence and increased degree of resolution in our pediatric consultations. It is our view that it should be strengthened via computer tools, in coexistence with the standard onsite care model, and complementing each other to better respond to the health demands of our population. © 2022, Spanish Association of Primary Care Pediatrics. All rights reserved.

14.
International Journal of Environmental Research and Public Health ; 19(9):5706, 2022.
Article in English | ProQuest Central | ID: covidwho-1837663

ABSTRACT

The aim of the current study was to explore consumer views on the management of anxiety in general practice, which is often the first service from which a consumer seeks professional support. We used a mixed methods survey to explore three broad research questions: (1) what are consumer experiences of anxiety management in general practice, (2) what do consumers prioritise when considering treatment for anxiety and what are their preferences for type of treatment, and (3) how do consumers think care for anxiety could be improved? Consumers reported generally positive views of their GP when seeking help for anxiety, though they had mixed experiences of the approach taken to treatment. Consumers noted that they prioritise effective treatment above other factors and are less concerned with how quickly their treatment works. A preference for psychological intervention or combined treatment with medication was apparent. Consumers noted that key areas for improving care for anxiety were improving access and funding for psychological treatments, increasing community knowledge about anxiety, and reducing stigma.

15.
International Journal of Environmental Research and Public Health ; 19(9):5522, 2022.
Article in English | ProQuest Central | ID: covidwho-1837548

ABSTRACT

Research shows that care delivery regarding somatic health problems for patients with a severe mental illness (SMI) in community and mental health is difficult to establish. During the last decade, long term mental health outreach teams in Belgium were implemented to provide treatment and follow-up at home. This study aimed to map physical health status, care professionals, health related quality of life and global functioning in persons with SMI in Belgian long term outreach teams for mental health. Using a self-administered questionnaire, 173 persons, 58.1% female with a mean age of 48.3, were questioned. Our findings suggest an undertreatment of somatic comorbid conditions, with only half of physical health complaints being addressed. Although treatment rates for hypertension, when detected were high, treatment of respiratory complaints, pain and fatigue was lacking. Although the majority of respondents responded to have a GP or psychiatrist, contact rates were rather limited. Other disciplines, such as primary care nurses, when present, tend to have more contact with people with SMI. Notably, having regular contacts with GPs seems to improve physical health complaints and/or treatment. Being treated by an outreach team did not show significant correlations with physical health complaints and/or treatment suggesting a more proactive approach by outreach teams or primary care providers is desirable.

16.
International Journal of Environmental Research and Public Health ; 19(9):4959, 2022.
Article in English | ProQuest Central | ID: covidwho-1837528

ABSTRACT

Australia is a federation of six states and two territories (the States). These eight governmental entities share responsibility for health and health services with the Australian Government. Mortality statistics, including causes of death, have been collected since the late 19th century, with national data produced by the (now) Australian Bureau of Statistics (ABS) from 1907. Each State introduced hospital in-patient statistics, assisted by State offices of the ABS. Beginning in the 1970s, the ABS conducts regular health surveys, including specific collections on Aboriginal and Torres Strait Islander peoples. Overall, Australia now has a comprehensive array of health statistics, published regularly without political or commercial interference. Privacy and confidentiality are guaranteed by legislation. Data linkage has grown and become widespread. However, there are gaps, as papers in this issue demonstrate. Most notably, data on primary care patients and encounters reveal stark gaps. This paper accompanies a range of papers from expert authors across the health statistics spectrum in Australia. It is hoped that the collection of papers will inform interested readers and stand as a comprehensive review of the strengths and weaknesses of Australian health statistics in the early 2020s.

17.
The Ultrasound Journal ; 14(1), 2022.
Article in English | ProQuest Central | ID: covidwho-1837285

ABSTRACT

BackgroundThe use of lung ultrasound (LU) with COVID-19 pneumonia patients should be validated in the field of primary care (PC). Our study aims to evaluate the correlation between LU and radiographic imaging in PC patients with suspected COVID-19 pneumonia.MethodsThis observational, prospective and multicentre study was carried out with patients from a PC health area whose tests for COVID-19 and suspected pneumonia had been positive and who then underwent LU and a digital tomosynthesis (DT). Four PC physicians obtained data regarding the patients’ symptoms, examination, medical history and ultrasound data for 12 lung fields: the total amount of B lines (zero to four per field), the irregularity of the pleural line, subpleural consolidation, lung consolidation and pleural effusion. These data were subsequently correlated with the presence of pneumonia by means of DT, the need for hospital admission and a consultation in the hospital emergency department in the following 15 days.ResultsThe study was carried out between November 2020 and January 2021 with 70 patients (40 of whom had pneumonia, confirmed by means of DT). Those with pneumonia were older, had a higher proportion of arterial hypertension and lower oxygen saturation (sO2). The number of B lines was higher in patients with pneumonia (16.53 vs. 4.3, p < 0.001). The area under the curve for LU was 0.87 (95% CI 0.78–0.96, p < 0.001), and when establishing a cut-off point of six B lines or more, the sensitivity was 0.875 (95% CI 0.77–0.98, p < 0.05), the specificity was 0.833 (95% CI 0.692–0.975, p < 0.05), the positive-likelihood ratio was 5.25 (95% CI 2.34–11.79, p < 0.05) and the negative-likelihood ratio was 0.15 (95% CI 0.07–0.34, p < 0.05). An age of ≥ 55 and a higher number of B lines were associated with admission. Patients who required admission (n = 7) met at least one of the following criteria: ≥ 55 years of age, sO2 ≤ 95%, presence of at least one subpleural consolidation or ≥ 21 B lines.ConclusionsLU has great sensitivity and specificity for the diagnosis of COVID-19 pneumonia in PC. Clinical ultrasound findings, along with age and saturation, could, therefore, improve decision-making in this field.

18.
International Journal of Environmental Research and Public Health ; 19(9):5675, 2022.
Article in English | ProQuest Central | ID: covidwho-1837211

ABSTRACT

Emerging literature is highlighting the huge toll of the COVID-19 pandemic on frontline health workers. However, prior to the crisis, the wellbeing of this group was already of concern. The aim of this paper is to describe the frequency of distress and wellbeing, measured by the expanded 9-item Mayo Clinic Wellbeing Index (eWBI), among general practitioners/family physicians during the COVID-19 pandemic and to identify levers to mitigate the risk of distress. Data were collected by means of an online self-reported questionnaire among GP practices. Statistical analysis was performed using SPSS software using Version 7 of the database, which consisted of the cleaned data of 33 countries available as of 3 November 2021. Data from 3711 respondents were included. eWBI scores ranged from −2 to 9, with a median of 3. Using a cutoff of ≥2, 64.5% of respondents were considered at risk of distress. GPs with less experience, in smaller practices, and with more vulnerable patient populations were at a higher risk of distress. Significant differences in wellbeing scores were noted between countries. Collaboration from other practices and perception of having adequate governmental support were significant protective factors for distress. It is necessary to address practice- and system-level organizational factors in order to enhance wellbeing and support primary care physicians.

19.
International Journal of Environmental Research and Public Health ; 19(9):5480, 2022.
Article in English | ProQuest Central | ID: covidwho-1837148

ABSTRACT

In 2021, over 100,000 people died prematurely from opioid overdoses. Neuropsychiatric and cognitive impairments are underreported comorbidities of reward dysregulation due to genetic antecedents and epigenetic insults. Recent genome-wide association studies involving millions of subjects revealed frequent comorbidity with substance use disorder (SUD) in a sizeable meta-analysis of depression. It found significant associations with the expression of NEGR1 in the hypothalamus and DRD2 in the nucleus accumbens, among others. However, despite the rise in SUD and neuropsychiatric illness, there are currently no standard objective brain assessments being performed on a routine basis. The rationale for encouraging a standard objective Brain Health Check (BHC) is to have extensive data available to treat clinical syndromes in psychiatric patients. The BHC would consist of a group of reliable, accurate, cost-effective, objective assessments involving the following domains: Memory, Attention, Neuropsychiatry, and Neurological Imaging. Utilizing primarily PUBMED, over 36 years of virtually all the computerized and written-based assessments of Memory, Attention, Psychiatric, and Neurological imaging were reviewed, and the following assessments are recommended for use in the BHC: Central Nervous System Vital Signs (Memory), Test of Variables of Attention (Attention), Millon Clinical Multiaxial Inventory III (Neuropsychiatric), and Quantitative Electroencephalogram/P300/Evoked Potential (Neurological Imaging). Finally, we suggest continuing research into incorporating a new standard BHC coupled with qEEG/P300/Evoked Potentials and genetically guided precision induction of “dopamine homeostasis” to diagnose and treat reward dysregulation to prevent the consequences of dopamine dysregulation from being epigenetically passed on to generations of our children.

20.
Allergol Immunopathol (Madr) ; 50(3): 8-14, 2022.
Article in English | MEDLINE | ID: covidwho-1836057

ABSTRACT

BACKGROUND: Respiratory infections (RI) significantly burden society, mainly when there are recurrent respiratory infections (RRI). Thus, there is a need to prevent RI in clinical practice. In this regard, the modulation of the immune system and resolution of the inflammatory cascade could represent an ideal way to prevent RI. Stimunex® gocce, a multicomponent food supplement, contains Sambucus nigra extract, ß-glucan, Zinc, and Vitamin D3. This study investigated its ability to prevent RRI in children using a real-world setting: the pediatric primary care. MATERIALS AND METHODS: Two hundred and ninety-eight children with RRI were enrolled in the current study. The food supplement was randomly prescribed to 160 children with RRI daily for 4 months (Active group); the remaining 138 children with RRI were treated only with standard therapy for RI (Control group). The number and duration of RI, parental perception of symptom severity and treatment efficacy, use of medications, and school and working absence were evaluated. RESULTS: Children treated with Stimunex® gocce had significantly less RI than the Control group, both concerning upper and lower RI (p˂0.001 and 0.003, respectively) during the follow-up period. Moreover, children in the Active group experienced shorter RI duration during the treatment and follow-up phases (p˂0.001 for both). In addition, parents of treated children perceived less severe symptoms and better treatment efficacy during the first and follow-up phases (p˂0.001 for all). The food supplement was well tolerated and there was no adverse event. CONCLUSIONS: The current real-world study demonstrated that Stimunex® gocce supplementation in children with RRI might safely prevent RI episodes and reduce RI duration. These outcomes should be highlighted as obtained during the COVID-19 pandemic era, characterized by a dramatic reduction of RI.


Subject(s)
COVID-19 , Respiratory Tract Infections , Child , Dietary Supplements , Humans , Pandemics , Primary Health Care , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/epidemiology
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