Implement social prescribing successfully towards embedding: what works, for whom and in which context? A rapid realist review.

BACKGROUND: Some clients who access healthcare services experience problems due to the wider determinants of health which cannot be addressed (solely) by the medical sector. Social Prescribing (SP) addresses clients ' wider health needs and is based on linkworkers who support primary care clients in accessing social, community and voluntary care services that support their needs. Previous literature has provided valuable insights about what works (or not) in an early stage of implementing SP. However, there is limited insight into what works for the implementation of SP towards embedding. This study provides guiding principles by which SP can be successfully implemented towards the embedding stage and identifies which contextual factors and mechanisms influence these guiding principles. METHODS: A Rapid Realist Review was conducted to examine what works, for whom, why, and in which contexts. A local Dutch reference panel consisting of health and care organisations helped to inform the research questions. Additionally, a workshop was held with the panel, to discuss what the international insights mean for their local contexts. This input helped to further refine the literature review's findings. RESULTS: Five guiding principles were identified for successful implementation of SP at the embedding stage: • Create awareness for addressing the wider determinants of health and the role SP services can play; • Ensure health and care professionals build trusting relationships with all involved stakeholders to create a cyclical referral process; • Invest in linkworkers' skills and capacity so that they can act as a bridge between the sectors; • Ensure clients receive appropriate support to improve their self-reliance and increase their community participation; • Invest in the aligning of structures, processes and resources between involved sectors to support the use of SP services. CONCLUSION: To embed SP, structural changes on a system level as well as cultural changes are needed. This will require a shift in attitude amongst health and care professionals as well as clients towards the use, role and benefit of SP services in addressing the wider determinants of health. It will also require policymakers and researchers to involve communities and include their perspectives.

The Health of a Migrant Population: A Phenomenological Study of the Experience of Refugees and Asylum Seekers in a Multicultural Context.

Refugees and asylum seekers bring with them a plurality of cultures, traditions, and values that could prove crucial in influencing perceived health needs, requests for intervention, or willingness to undergo specific health treatments. Although studies have focused on the health consequences of forced migration, in recent years, there has been a lack of information on how refugees and asylum seekers represent their experiences of perceived health needs and elements that influence well-being, in a community context. This study aims to explore the experience of refugees and asylum seekers in an Italian multicultural community about perceived health needs. A qualitative phenomenological study was conducted with an interpretive approach. The data were collected using a semi-structured face-to-face interview. The interviews were transcribed, read thoroughly, and analyzed. Nineteen refugees and asylum seekers were interviewed. Three main themes were extracted: (1) the centrality of the family to feel healthy; (2) feeling part of a community; and (3) stability and security. The results confirm that health needs, experiences, and different cultural representations of health and illness should be read and addressed with a culturally competent vision. This study was not registered.

Association between the hearing aid and mental health outcomes in people with hearing impairment: A case-control study among 28 European countries.

BACKGROUND: Hearing loss affects over 1.5 billion individuals globally, with significant implications for mental health. This study investigates the association between hearing aid use and mental health outcomes, by particularly focusing on depression and unmet mental health needs (UMHN), across a diverse international sample. METHODS: Utilizing data from the third wave of the European Health Interview Survey (EHIS), this study involved 17,660 participants with hearing impairment from 28 countries. The study examined the association between hearing aid use and mental health outcomes, including the likelihood of moderate and severe depression and UMHN due to lack of contact with general practitioners (GPs) and mental health specialists. Logistic regression models, adjusted for socio-demographic characteristics, health risk behaviours, and other relevant variables, were employed. Inverse probability weights were used to mitigate potential selection bias. RESULTS: Hearing aid usage was associated with significantly lower likelihoods of moderate depression (Odds Ratio [OR] = 0.58, 95%CI = [0.54, 0.63]) and severe depression (OR = 0.61, 95%CI = [0.55, 0.69]), compared to non-usage. Hearing aid usage was also associated with reduced UMHN due to lack of GP contact for moderate (OR = 0.82, 95%CI = [0.75, 0.89]) and severe depression (OR = 0.75, 95%CI = [0.59, 0.95]). The depression risk reductions were greater among females and higher-educated subgroups but lower in individuals aged ≥65 years. Income level and rurality also impacted UMHN due to the lack of GP contact. No associations were found between hearing aids and UMHN due to the lack of mental health specialist contact. CONCLUSIONS: Hearing aid adoption showed protective associations against mood disorders and lowered unmet primary mental healthcare needs. Tailoring intervention strategies to vulnerable sociodemographic profiles could optimize mental health benefits among those with hearing loss. Integrating hearing health services within mental healthcare delivery frameworks is vital amidst the rising global burden.

Voices of care: unveiling patient journeys in primary care for hypertension and diabetes management in Kerala, India.

Background: Diabetes and hypertension are leading public health problems, particularly affecting low- and middle-income countries, with considerable variations in the care continuum between different age, socio-economic, and rural and urban groups. In this qualitative study, examining the factors affecting access to healthcare in Kerala, we aim to explore the healthcare-seeking pathways of people living with diabetes and hypertension. Methods: We conducted 20 semi-structured interviews and one focus group discussion (FGD) on a purposive sample of people living with diabetes and hypertension. Participants were recruited at four primary care facilities in Malappuram district of Kerala. Interviews were transcribed and analyzed deductively and inductively using thematic analysis underpinned by Levesque et al.'s framework. Results: The patient journey in managing diabetes and hypertension is complex, involving multiple entry and exit points within the healthcare system. Patients did not perceive Primary Health Centres (PHCs) as their initial points of access to healthcare, despite recognizing their value for specific services. Numerous social, cultural, economic, and health system determinants underpinned access to healthcare. These included limited patient knowledge of their condition, self-medication practices, lack of trust/support, high out-of-pocket expenditure, unavailability of medicines, physical distance to health facilities, and attitude of healthcare providers. Conclusion: The study underscores the need to improve access to timely diagnosis, treatment, and ongoing care for diabetes and hypertension at the lower level of the healthcare system. Currently, primary healthcare services do not align with the "felt needs" of the community. Practical recommendations to address the social, cultural, economic, and health system determinants include enabling and empowering people with diabetes and hypertension and their families to engage in self-management, improving existing health information systems, ensuring the availability of diagnostics and first-line drug therapy for diabetes and hypertension, and encouraging the use of single-pill combination (SPC) medications to reduce pill burden. Ensuring equitable access to drugs may improve hypertension and diabetes control in most disadvantaged groups. Furthermore, a more comprehensive approach to healthcare policy that recognizes the interconnectedness of non-communicable diseases (NCDs) and their social determinants is essential.

Caregivers' experience of caring for family members with complex health needs in Latvia.

The article examines the experiences of family caregivers engaged in the provision of long-term care for their relatives with complex health needs within the Latvian context. Semi-structured interviews were conducted with seven caregivers who provide care in cases of dementia, depression, schizophrenia, opioid use, Down syndrome and mild cognitive impairment. A thematic analysis of interview transcripts revealed common themes, such as the initial experiences when encountering a family member's disorder and the subsequent reactions, as well as the quest for support and resources. Variations mainly centered around differences in formal aspects and childhood experiences of care. Caregivers reported risk factors such as guilt, lack of support from family and friends, financial difficulties, deficiency of professional care and ignoring the caregiver's own needs. Awareness of personal resources, values and limits, coping with personal stigma and improved overall quality of life were identified as protective factors. The findings underscore several preventive measures that social and mental health services could implement to mitigate the adverse effects of caregiving on caregivers' lives.

Determinants of postpartum depression among women in Kampong Chhnang Province, Cambodia.

OBJECTIVE: This study aimed to identify the prevalence of postpartum depression (PPD) and the factors associated with PPD in Kampong Chhnang Province, Cambodia. STUDY DESIGN: A cross-sectional study. PARTICIPANTS: This study included 440 Cambodian women at 6-8 weeks postpartum who visited health centers between July and September 2021. MATERIALS AND METHODS: Data were collected through face-to-face interviews by midwives and nurses using a structured questionnaire. The Edinburgh Postnatal Depression Scale (EPDS) in the Khmer language was used to screen for PPD, and suspected PPD was defined as a total EPDS score ≥ 10. Logistic regression analyses were performed to identify the factors associated with suspected PPD. FINDINGS: The average age of participants was 28.6 years old. The prevalence of suspected-PPD was 30.2 % (n = 133). Factors associated with suspected PPD were income dissatisfaction (adjusted odds ratio (AOR) = 2.66, 95 % confidence interval (CI) 1.27-5.56, P = 0.010), unintended pregnancy (AOR = 1.99, 95 % CI 1.10-3.61, P = 0.023), and a partner employed as a manual laborer (AOR = 3.85, 95 % CI 1.11-13.33, P = 0.034), farmer (AOR = 3.69, 95 % CI 1.11-12.31, P = 0.034), and factory worker (AOR = 5.43, 95 % CI 1.38-21.41, P = 0.016). In addition, poor relationship with partners (AOR = 2.14, 95 % CI 1.17-3.94, P = 0.014), poor relationship with mother-in-law (AOR = 3.51, 95 % CI 1.70-7.21, P < 0.001), and a history of depression before pregnancy (AOR = 6.34, 95 % CI 1.59-25.34, P = 0.009) were significantly associated with suspected-PPD. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study highlighted the need for mental health services in primary healthcare settings. Mental health training for healthcare workers, particularly primary-level nurses, should be prioritized and strengthened. Further clinical study on EPDS validation should be carried out to justify the appropriate cut-off EPDS score for Cambodian women. The EPDS should be integrated into routine PNC services to identify women with suspected-PPD. Education on PPD should be provided not only to the nurses and midwives, but also to the women and their families to support the mental health of pregnant and postpartum women.

The Comparison of Lifestyles, Mental Risks, and Physical Indices among Individuals with Ultra-High Risk of Psychosis, Patients with Schizophrenia, and the General Public.

(1) Background: Early interventions may effectively reduce the risk of mental disorders in individuals with ultra-high risk. Specifying the health needs of individuals with ultra-high risk is crucial before the implementation of successful early intervention. This study aimed to explore the differences in lifestyles, mental risks, and physical indices among individuals with ultra-high risk, patients with schizophrenia, and healthy subjects. (2) Methods: A cross-section design applying seven questionnaires with physical examinations for 144 participants aged 13-45 years old was conducted in this study. The questionnaires included one about personal data, four on mental risks, and two for lifestyles. (3) Results: The individuals with ultra-high risk scored similarly in many dimensions as the patients with schizophrenia, but they displayed lower positive symptoms, lower negative symptoms, lower prodromal symptoms, higher interpersonal deficits, lower nutrition intake, and higher levels of exercise than the patients with schizophrenia. Female individuals with ultra-high risk had lower self-esteem, higher positive symptoms, lower nutrition intake, and higher exercise levels than male ones. (4) Conclusions: The study pinpointed specific health needs with interpersonal deficits, nutrition intake, and physical activity for the individuals with ultra-high risk. Future interventions targeted on improving social function, dietary pattern, and exercise will be beneficial.

"We want our freedom back, that's our only need": a qualitative study of health and social needs among asylum seekers and undocumented migrants crossing the borders from Belarus to Lithuania.

Background: The influx of undocumented migrants and asylum seekers into Lithuania, particularly during the COVID-19 pandemic, presents unique public health challenges. This study employs the Social Determinants of Health framework to explore the healthcare and social needs of this vulnerable population. Methods: In May 2022, we carried out a qualitative study through semi-structured interviews with asylum seekers across four centers in Lithuania. Employing both purposive and snowball sampling techniques, we selected participants for our investigation. The study comprised 21 interviews-19 conducted in Arabic and 2 in English-with durations ranging between 20 and 40 min each. We audio-recorded all interviews, transcribed them verbatim, and subsequently performed a thematic analysis using Atlas.ti software. This process of design and analysis strictly followed the principles of thematic analysis as outlined by Braun and Clarke, guaranteeing methodological precision and rigor. Findings: 21 interviews revealed critical insights into the healthcare access challenges, mental health issues, and social integration barriers faced by the participants. Key themes included 'Healthcare Needs and the Impact of the COVID-19 Pandemic 'and 'Social needs and Aspirations Amidst Pandemic-Induced Uncertainty '. The findings highlight the multifaceted healthcare and social needs of asylum seekers, juxtaposed against significant barriers they face. Access to medical services is hindered by long waiting times and financial constraints, especially for specialized care such as dental services. Communication issues during medical appointments due to language barriers and the lack of gender-specific healthcare, such as access to gynecological services, further exacerbate the challenges. Additionally, the COVID-19 pandemic introduces hurdles such as limited testing, isolation measures, language-specific information barriers, and insufficient social distancing practices. Mental health has emerged as a critical concern, with asylum seekers reporting significant stress and emotional exhaustion due to uncertainty and restrictive living conditions. Social needs extend to delayed asylum application processes, inconsistent language education opportunities, inadequate clothing, and nutrition that lacks cultural sensitivity, and living conditions characterized by overcrowding and insufficient facilities. The restricted freedom of movement within asylum seeking centres severely impacts their psychological well-being, underscoring a deep longing for autonomy and a better life despite the myriad of challenges faced. Discussion: The study illustrates the complex interplay between migration, health, and social factors in the context of a global pandemic. It highlights the need for culturally sensitive healthcare services, mental health support, and structured language education programs. Offering educational avenues alongside language courses for children and adults is essential for fostering social inclusion and securing economic prosperity. Addressing the challenge of language barriers is of utmost importance, as these barriers significantly impede undocumented migrants' and asylum seekers employment opportunities and their access to crucial services. The findings emphasized immigration as a health determinant and underscored the importance of inclusive health policies and advocacy for undocumented migrants and asylum seekers' rights and needs. Conclusion: There is an urgent need for comprehensive policies and practices that are grounded in the principles of equity, compassion, and human rights. Additionally, advocating for practice adaptations that are culturally sensitive, linguistically inclusive, and responsive to the unique challenges faced by undocumented migrants and asylum seekers. As global migration continues to rise, these findings are crucial for informing public health strategies and social services that cater to the diverse needs of this vulnerable population.

An early economic evaluation of Kooth, a web-based mental health platform for children and young people with emerging mental health needs.

Background: "Kooth" is a web-based mental health platform commissioned by the National Health Service (NHS), local authorities, charities, and businesses in the UK. The platform gives children and young people (CYP) access to an online community of peers and a team of counsellors. This study reports an early economic evaluation of the potential benefits of Kooth in the UK. Methods: An early evidence cost calculator was built to estimate the potential costs and savings of implementing Kooth from a UK NHS and crime sector perspective. A decision tree structure was used to track the progress of CYP with emerging mental health needs (EMHN), comparing CYP with access to Kooth to CYP without access to Kooth. The model implemented a 12-month time horizon and followed a typical Kooth contract in relation to costing, engagement, and CYP demographics. Results: The base case results followed a cohort of 2160 CYP. The results of the cost calculator estimated that engagement with Kooth is associated with a cost saving of £469,237 to the NHS across a 12-month time horizon, or £236.15 per CYP with an EMHN. From a combined NHS and UK crime sector perspective, the cost savings increased to £489,897, or £246.54 per CYP with an EMHN. The largest cost savings were provided by an estimated reduction of 5346 GP appointments and 298 antidepressant prescriptions. For this cohort, the model predicted that engagement with Kooth averted 6 hospitalisations due to suicidal ideation and 13 hospitalisations due to self-harm. Furthermore, the number of smokers and binge drinkers was reduced by 20 and 24, respectively. When a crime sector perspective was taken, 3 crimes were averted. Discussion: This early model demonstrates that Kooth has the potential to be a cost-saving intervention from both an NHS and a combined NHS and UK crime sector perspective. Cost savings were provided through aversion in clinical and social outcomes. The model used a conservative approach to balance the uncertainty around assumptions of the intermediate outcomes (GP and medication use). However, it is limited by a paucity of costing data and published evidence relating to the impact of digital mental health platforms.

Black Alaskans Health Needs Assessment during COVID-19 Pandemic: Implications for Social Work.

At the peak of the COVID-19 pandemic it became clear that Black people were experiencing more severe symptoms and had higher rates of mortality from COVID-19 than White people. However, data on racial differences in death and hospitalization rates in Alaska were less clear. To address this, the Alaska Black Caucus initiated the first Black Alaskans health needs assessment to understand the health status, needs, and resources of the Black community of Alaska. This article reports on the design, implementation, and descriptive results from the survey portion of the first community health needs assessment of Black Alaskans. The findings indicate that a majority of Black Alaskans report being moderately healthy, having access to health insurance, owning their homes, and having a favorable view of their neighborhood. However, too many are unable to work due to poor physical or mental health challenges and are diagnosed with one or more chronic health diseases. In addition, Black Alaskans experience high rates of substance abuse, have untreated mental health conditions, consume tobacco products at a high rate, and are not screening for some cancers. The article will conclude by presenting additional strategies for improving healthcare access and responsiveness for Black Alaskans.

Health literacy profiles of pregnant women and mothers in Tasmania: A cluster analysis.

ISSUE ADDRESSED: Health literacy development can help to reduce the growing noncommunicable disease burden globally. However, less is known about the health literacy needs of pregnant women and mothers necessary to guide health literacy development in this priority population group. To enhance the understanding of the health literacy needs of pregnant women and mothers, this study aimed to develop data-informed health literacy profiles of pregnant women and mothers with children (0-8 years) in Tasmania, as well as data-informed vignettes describing the health literacy needs of women in the different health literacy profiles. METHODS: An online cross-sectional survey was undertaken. The survey included demographic questions and the health literacy questionnaire (HLQ). The data were analysed using a cluster analysis to identify subgroups with varying health literacy needs. The clusters, in conjunction with demographic characteristics, were used to generate data-informed vignettes representing various health literacy profiles. RESULTS: The cluster analysis generated seven health literacy profiles and five vignettes representing diverse health literacy needs of pregnant women and mothers in Tasmania. Each vignette tells a data-informed story of women in Tasmania experiencing diverse health literacy strengths and challenges influencing their access and use of health information and health services. This allowed deeper exploration of the health literacy needs of the subgroups within the target population. CONCLUSION: A better understanding of the health literacy needs of pregnant women and mothers can provide policymakers and health care providers with the key insights needed to guide the planning and development of fit-for-purpose solutions. This understanding can also guide the tailoring of existing health and community services, to create a health literacy-responsive environment that is more likely to meet the diverse health needs of pregnant women and mothers. SO WHAT: We must shift away from a 'one size fits all' approach and promote the development of a health literacy-responsive environment to improve health and equity outcomes for pregnant women and mothers in Tasmania.

Associations Between Sociodemographic Variables, Social Determinants of Health, and Diabetes: Findings From a Congregational Health Needs Assessment.

PURPOSE: To examine associations between sociodemographic variables, social determinants of health (SDOHs) and diabetes using health needs assessment data. DESIGN: Cross-sectional study. SETTING: Faith-based communities in the Mid-South U.S. SAMPLE: Of the 378 churches, 92 participated in the study (24% response rate); N = 828 church leaders and members completed the survey. MEASURE: The Mid-South Congregational Health Survey assessed perceived health-related needs of congregations and the communities they serve. ANALYSIS: Generalized linear mixed modeling examined the associations between sociodemographic variables (age, sex, race/ethnicity, educational level), SDOHs (affordable healthcare, healthy food, employment), and diabetes. RESULTS: Individuals with less education had lower odds of reporting all SDOHs as health needs compared to individuals with more education (ORrange = .59-.63). Men had lower odds of reporting diabetes as a health need or concern compared to women (OR = .70; 95% CI = .50, .97). African Americans had greater odds of reporting diabetes as a health need compared to individuals in the 'Other' race/ethnicity category (OR = 3.91; 95% CI = 2.20, 6.94). Individuals who reported affordable healthcare (OR = 2.54; 95% CI = 1.73, 3.72), healthy food (OR = 2.24; 95% CI = 1.55, 3.24), and employment (OR = 3.33; 95% CI = 2.29, 4.84) as health needs had greater odds of reporting diabetes as a health need compared to those who did not report these SDOHs as needs. CONCLUSIONS: Future studies should evaluate strategies to merge healthcare and faith-based organizations' efforts to address SDOHs impacting diabetes.

Inclusion of People With Disabilities in Community Health Needs Assessments in Florida, United States.

Community health needs assessments (CHNAs) play a crucial role in identifying health needs of communities. Yet, unique health needs of people with disabilities (PWDs) are often underrecognized in public health practice. In 2010, the Patient Protection and Affordable Care Act (ACA) required the implementation of standardized data collection guidelines, including disability status, among federal agencies. The extent to which guidance from ACA and the U.S. Centers for Disease Control and Prevention has impacted disability inclusion in CHNAs is unknown. This study used a content analysis approach to review CHNAs conducted by local health councils and the top 11 nonprofit hospitals in Florida (n = 77). We coded CHNAs based on mentioning disability in CHNA reports, involving disability-related stakeholders, and incorporating data on disability indicators. Findings indicate that PWDs are widely not included in CHNAs in Florida, emphasizing the need for equitable representation and comprehensive understanding of PWDs in community health planning.

Health and social care needs of people living with dementia: a qualitative study of dementia support in the Victorian region of Gippsland, Australia.

INTRODUCTION: There is a lack of information about the experiences of people living with dementia and their carers, especially in rural and regional areas. Understanding these experiences helps to identify gaps and unmet needs within the health system and improve quality of care and outcomes for people living with dementia. The aim of this study was to improve our knowledge of dementia support needs. This included access to health and social care services and supports for people living with dementia and those who provide informal or formal support to someone living with dementia. METHODS: Interviews were conducted with 26 participants from the Gippsland region of Victoria, Australia with knowledge of dementia care. Purposive sampling engaged people with lived experience, carers/family members and health professionals delivering dementia care and social services. Discussions centred around participants' experiences of support services, the diagnosis process and what they thought was needed to improve the services and supports offered. Thematic analysis of the data was undertaken using the framework method. RESULTS: The interview data indicated that the needs of many people living with dementia and their carers were not currently being met. The themes were limited access to services and supports, including primary and specialist care, often impacted by lack of knowledge of care options, difficulty navigating the system and funding models as a barrier, leading to delays in getting a diagnosis and accessing specialist services; lack of holistic care to enable people living with dementia to 'live well'; and stigma impacted by a lack of knowledge of dementia among professionals and in the community. Relationship-centred care was described as a way to improve the lives of people living with dementia. CONCLUSION: Key areas for improvement include increasing community awareness of dementia and available local services, more support to obtain an early dementia diagnosis, increased help to navigate the system, especially immediately after diagnosis, and easier access to appropriate home support services when they are needed. Other recommendations include person-centred care across settings - supported by funding models, more education and communication skills training for health professionals and care staff - and greater support for and increased recognition of carers.

Addressing the Mental Health Needs of Transgender and Gender Diverse Adult Patients Seeking Facial Surgery.

Transgender and gender diverse (TGD) patients may present to a surgical context with complex mental health challenges, many of which stem from external stressors. TGD patients also may face disparities regarding the accessibility and quality of health care experiences, which also erodes the mental health of patients. Providers who offer gender-affirming surgery need to be aware of the context that patients may arrive in and install practices that can address the needs of TGD patients.

Nurse perceptions of caring for pediatric patients with behavioral health needs on non-psychiatric units during the COVID-19 pandemic.

PURPOSE: The study examined nurses' perceptions of barriers and needs when caring for pediatric patients with behavioral health needs in inpatient non-psychiatric units during the pandemic. DESIGN AND METHODS: A quantitative descriptive comparative design was used. Members of Society of Pediatric Nurses and National Pediatric Nurse Scientist Collaborative were recruited. The survey included questions about perceived barriers and needs in caring for children with behavioral health needs in their units. RESULTS: A total of 335 nurses across the United States participated. Descriptive statistics, chi-square, and Kruskal-Wallis evaluated responses. Nurses in Southeast/Southwest regions were less fearful when caring for pediatric patients with behavioral health needs (p = .03), more often knew what to do (p = .01), and were supported by a behavioral health team with regular rounding (p = .035). Nurses in adult/pediatric hospitals were less likely to have adequate education to feel competent (p = .012). Nurses in the emergency department were less fearful (p = .02), more confident (p = .025), and more competent (p = .006). Nurses with up to two years of experience were likelier to feel assignments reflected the patient workload (p = .001) and more familiar with trauma-informed care protocols (p = .013). CONCLUSIONS: This study illustrated significant variations in competence, readiness, and attitudes among nurses across different regions, hospital types, departments, and experience levels when caring for pediatric patients with behavioral health needs. PRACTICE IMPLICATIONS: Results from this study could lead to the development of clinical practice guidelines, protocols, or policies to guide practice.

A tessitura dos discursos na construção diagnóstica da fibrose cística: uma perspectiva sobre acesso e barreiras / The intertwining of discourses in the diagnostic construction of cystic fibrosis: a perspective on access and barriers

Resumo As complexidades referidas na busca pela "exatidão" no diagnóstico da fibrose cística (FC) apontam para reflexões em torno de "o que é preciso" na atual conjuntura da "medicina de precisão". Analisamos os discursos de 19 atores sociais pertencentes à comunidade de especialistas na fibrose cística, explorando as acepções semânticas do vocábulo "precisão" e as barreiras ao diagnóstico e às inovações na terapêutica. Adotamos a análise crítica do discurso de Norman Fairclough a fim de alcançar as construções discursivas em torno da integralidade do cuidado, da garantia e oferta equitativa dos básicos sociais. O acesso foi identificado como categoria êmica quando nas arenas sociais de disputa estão as necessidades de saúde e o direito à vida.

Abstract The complexities referred to in the search for "accuracy" in the diagnosis of cystic fibrosis (CF) point to reflections around "what is needed" in the current situation of "precision medicine". We analyzed the discourses of 19 social actors belonging to the community of specialists in cystic fibrosis, exploring the semantic meanings of the word "precision", and the barriers to diagnosis and innovations in therapeutics. We adopted the critical discourse analysis (CDA) of Norman Fairclough in order to achieve the discursive constructions around the integrality of care, the guarantee and equitable supply of basic social needs. Access was identified as an emic category when in the social arenas of dispute are health needs and the right to life.

Equipping undergraduate medical and nursing students with elderly health care assessment skills at Makerere University, College of Health Sciences, Uganda.

BACKGROUND: Elderly health care training and aging science remain the least prioritized discipline of medical education in many African countries. With scant scientific evidence on elderly health care in low-income countries, coupled with limited exposure to elderly health care training, this project aimed to equip undergraduate health professional students with elderly health care assessment skills and research through an online course and a clinical placement. METHODS: Students (3rd year) underwent online elderly health care training through the Alison courses published by the Advanced Learning Academy in Ireland. The students were then subjected to an online exam with a pass mark of 80%. Students were also trained on standard elderly health care assessment tools through a one-day session. For practical skills on data collection, each student assessed 15 elderly patients at the Mulago National Referral Hospital Assessment Centre. All tools once filled in were assessed for completion. A one-day reflection session was held with students, faculty and the project leads to share findings from the various tools used to assess elderly individuals. The students shared their experiences and provided feedback on the online training as well as the hardships they may have experienced while administering the tools. A certificate of participation was provided to the students at the end of the project. RESULTS: All the students (10) gained knowledge on elderly assessment skills, the impact of aging on various body systems, and how to manage common occurrences among elderly individuals. The average score in the post-exam was 82% (standard deviation ± 2.01). All students (10) reported having had this as their first training on the assessment of functionality among elderly individuals. CONCLUSIONS: The students gained knowledge of elderly health assessments as well as the impact of aging on various body systems. They also gained insight into how to care for the elderly holistically with an added understanding of how to manage spinal and traumatic brain injuries.

Access to Healthcare and Unmet Needs in the Canadian Lesbian-Gay-Bisexual Population.

Individuals who identify as a sexual minority, including those who are lesbian, gay, or bisexual (LGB), face barriers to healthcare as well as increased discrimination, stigmatization, and negative experiences during healthcare use. Further, few healthcare providers have education and training focused on the specific healthcare needs of individuals who are part of a sexual minority group. Given the limited research on Canadian healthcare access for sexual minorities, our purpose was to use data (n > 2,800) from the 2015-16 Canadian Community Health Survey (CCHS) to investigate the perceptions of healthcare access for LGB and non-LGB Canadians. Although non-LGB and LGB participants reported comparable access to a regular care provider and were equally likely to have consulted with a general practitioner in the past 12 months, LGB respondents were more likely to have seen a specialist and reported more unmet health needs. Although we expected the linear effects of both race and sex to vary by LGB status, this effect only occurred in one model. Current results have implications for addressing health inequalities for sexual minorities, including poorer health outcomes and greater discrimination.

Factors Associated with Physical Activity Increases and Decreases Among a Sample of Appalachian Residents During the COVID-19 Pandemic: A Cross-Sectional Study.

Introduction: Physical activity (PA) can prevent and reduce the deleterious physical and mental health effects of COVID-19 and associated lockdowns. Research conducted early in the pandemic demonstrates that a greater proportion of adults in the U.S. have decreased than increased PA, and the effects vary by sociodemographic factors. Ongoing evidence is important to identify patterns in PA changes during the pandemic. Purpose: This study aims to identify factors associated with increases and decreases in PA during the COVID-19 pandemic in a convenience sample of adults residing in Appalachia. Methods: Surveys were collected from a convenience sample of adults from eight counties in West Virginia from January to March 2021. Logistic regression analysis was used to identify sociodemographic, health, and rurality factors associated with (1) increased PA and (2) decreased PA during the pandemic, assessed retrospectively via self-report. Results: Analysis of 1,401 survey responses revealed that better self-rated health, lower body mass index, and higher income and education were associated with a greater likelihood of more time spent doing PA during the pandemic ( p ≤ .05). Respondents with lower self-rated health, higher body mass index, lower income, and lower levels of education-plus females and those living in a more urban county-were more likely to spend less time doing PA during the pandemic ( p ≤ .05). Implications: Analyses suggest that pre-pandemic disparities in PA by health, wealth, and education were exacerbated during the pandemic. These must be addressed before physical inactivity and ill health become endemic to the Appalachian Region.