Prevalence and determinants of Internet Addiction among medical students and its association with depression.

BACKGROUND: Internet addiction has been a topic of discussion in the academic literature for many years. As of April 2020, about 60 % of the world's population (nearly 4.6 billion people) were active internet user in their early adulthood. The prevalence among adolescent and college students ranged from 0.9 % to 33 %. The current study aimed to explore internet addiction's prevalence and correlates among undergraduate medical students at an Egyptian university. Also, to assess the relationship between internet addiction, depression symptoms, and socioeconomic status. METHODS: A cross-sectional study of 321 undergraduate medical students at Assiut University using the Internet Addiction Scale, Patient Health Questionnaire, and Family Affluence Scale. RESULTS: About 9 % of the study participants screened positive for internet addiction. The most important determinants among medical students were sex, mother's employment status, family affluence, depressive symptoms, and unmonitored internet access. LIMITATIONS: We did not investigate another psychiatric disease, daily time of internet usage, most frequent time of usage, type of internet usage, and cost of use. CONCLUSIONS: Internet Addiction is an important psychological problem affecting about 9 % of Assiut university medical students during their undergraduate stage, which may interfere with their lives and studies. Students with lower Internet addiction rates were female students whose mothers were employed, lived in a low affluence family, had fewer depressive symptoms, and had unmonitored internet privacy.

Towards an Understanding of Population Health Data in a Single NHS Trust during COVID-19.

The objective of this study was to determine the further care needs of people discharged from the hospital following a COVID-19 illness from April-September 2020. Methods: In partnership with an NHS trust in the UK, data analysis was undertaken by linking data from the Trust, to facilitated a triage process. The intention was to provide information in a format that enabled an examination of the population data and highlight any inequality in provision. Data were mapped onto the indices of multiple deprivation, and a range of text and graphical methods were used to represent the population data to the hospital leadership. The visual representation of the demographics and deprivation of people discharged during a critical period of the pandemic was intended to support planning for community services. The results demonstrated that just under half of those discharged were from the poorest fifth of the English population and that just under half were aged 75 or older. This reflected the disproportional effect of COVID-19 on those who were poorer, older or had pre-existing multiple morbidities. Referral to community or outpatient services was informed by the analysis, and further understanding of the diversity of the population health was established in the Trust. Conclusion: By identifying the population and mapping to the IMD, it was possible to show that over half of discharged patients were from deprived communities, and there was significant organisational learning bout using data to identify inequalities.. The challenge of planning services that target underserved communities remains an important issue following the pandemic, and lessons learnt from one health system are being shared.

Psychological impact of caring during the COVID-19 pandemic on HIV nurses.

The COVID-19 pandemic has created a set of unprecedented challenges for healthcare services and staff. The authors conducted a national online survey of nurses employed to work in HIV services in England, Wales, Scotland, Northern Ireland and the Republic of Ireland to establish how the COVID-19 pandemic has impacted on the professional quality of life of HIV nurses. Professional quality of life was assessed using the ProQOL scale; 132 nurses completed the survey, 99 of whom completed the ProQOL scale. Just over 1 in 3 were redeployed in the first pandemic wave, dropping to 1 in 6 in subsequent waves. In multivariate analysis, redeployment in both waves increased burnout scores by nearly 10 points and decreased compassion satisfaction scores by nearly 5 points, with no effect on secondary traumatic stress scores. A supportive workplace environment will have a key role in supporting the path to recovery.

Student nurses' career intentions following placements in general practice through the advanced training practices scheme (ATPS): findings from an online survey.

BACKGROUND: The demand for General Practice services in the UK, and elsewhere, is rising quickly. In part, the increasing demand is from an aging population that requires management of multiple long-term conditions. The General Practice Nurse is increasingly taking on the role. It is acknowledged that if general practice is to be able to recruit sufficient General Practice Nurses (GPNs) to meet this increasing demand in the future, new graduate nurses must be encouraged to consider general practice as a viable career option. This research is part of a review of the Advanced Training Practice Scheme (ATPS) which supported clinical placements in participating general practices. METHODS: The aim of the study was to examine nursing students' perceptions of GP placements, and their effect upon career intentions following graduation from Sheffield Hallam University (SHU), in the UK. Interviews and an online survey were used collect data. Only the survey is reported here. The bespoke survey examined students' views of: opportunities for learning new clinical skills and consolidating existing clinical skills; the learning environment in general practice and their views on a career in general practice. RESULTS: One thousand one hundred twenty undergraduate adult-field nursing students were contacted, with a response rate of 41% (N = 462). Ninety respondents had a placement and, 92% (N = 84) viewed practice nursing positively, and 77% (N = 70) felt that the placement had transformed their views on general practice. The opportunity to participate in the management of the various aspects of chronic disease was identified by 84% (N = 76) of the students as a key new skill they had acquired. They also reported that they valued a team ethos, control over aspects of work, and the variety of health problems they encountered. CONCLUSION: The findings from this study demonstrate a positive experience arising from the provision of General Practice placements for nursing students. The use of 'targeted' placement schemes with appropriate support such as this may be seen as a viable way of exposing nursing students to General Practice nursing, and of encouraging new graduate nurses to consider General Practice nursing as a viable career option.

GP/GPN partner* perspectives on clinical placements for student nurses in general practice: can a community of practice help to change the prevailing culture within general practice?

BACKGROUND: The UK Government document 5 year forward view describes the need to move chronic disease management from secondary to primary care, which will require a significant increase in the numbers of General Practice Nurses (GPNs). Until recently, there has been no specific recruitment strategy to address this increased need. In recent times, a number of solutions have been suggested to address this impending GPN recruitment crisis. For example, Health Education England (HEE) commission General Practitioners (GPs), who are members of the Advanced Training Practice Scheme (ATPS), to provide placements for student nurses within general practice. METHODS: A descriptive qualitative study was undertaken, in which data were collected using semi-structured interviews with 16 GPs and 2 GPN partners*. Qualitative analysis used a framework approach and themes were cross-checked within the team and member checking was undertaken with a convenience sample of GPs. The research had ethical approval and anonymity and confidentiality were maintained. RESULTS: From the GP perspective, there were two key themes that emerged from the data. The first theme of 'fishing in the same small pond' included succession planning for the general practice workforce, the 'merry go round' of poaching staff from other practices, and the myths and misunderstandings that have grown up around general practice nursing. The second theme, 'growing your own', looked at the impact of the student nurse placements as a means to address the crisis in GPN recruitment. There was recognition of the need for cultural change in the way that GPNs are recruited, and that the ATPS was one way of helping to achieve that change. There were however a number of challenges to sustaining this cultural shift, such as the financial constrains placed upon the GP practice, and the need to function as a 'small business'. CONCLUSIONS: Despite all the challenges, the evidence is that, through the Community of Practice (CoP), the ATPS scheme is beginning to 'bear fruit', and there is a subtle but discernible move by GPs from a 'why would we?' to 'why wouldn't we?' invest in education and training for nurses in general practice. N.B. The term GPN partner* denotes a GPN who is a 'full partner' in the practice business, holding the same NHS contracts and the same status as a GP. For the purposes of the paper itself, the term GP will be used to denote both types of partner.

Who attends out-of-hours general practice appointments? Analysis of a patient cohort accessing new out-of-hours units.

OBJECTIVES: This report describes the patients who used additional out-of-hours (OOH) appointments offered through a UK scheme intended to increase patient access to primary care by extending OOH provision. DESIGN: Cohort study and survey data. SETTING: OOH appointments offered in four units in one region in England (October 2015 to November 2016). METHODS: Unidentifiable data on all patients were abstracted from a bespoke appointment system and the responses to a patient opinion questionnaire about this service. Descriptive analysis of the appointment data was conducted. Multivariate analysis of the opinion survey data examined the characteristics of the patients who would have gone to the emergency department (ED) had the OOH appointments not been available. RESULTS: There were 24 448 appointments for 19 701 different patients resulting in 29 629 service outcomes. Women dominated the uptake and patients from the poorest fifth of the population used nearly 40% of appointments. The patient survey found OOH appointments were extremely popular-93% selecting 'extremely likely' or 'likely' to recommend the service. Multivariate analysis of patient opinion survey data on whether ED would have been an alternative to the OOH service found that men, young children, people of Asian heritage and the most deprived were more likely to have gone to ED without this service. CONCLUSIONS: The users of the OOH service were substantially different from in-hours service users with a large proportion of children under age 5, and the poor, which support the idea that there may be unmet need as the poor have the least flexible working conditions. These results demonstrate the need for equality impact assessment in planning service improvements associated with policy implementation. It suggests that OOH need to take account of patients expectations about convenience of appointments and how patients use services for urgent care needs.

Changing hearts and minds: examining student nurses' experiences and perceptions of a general practice placement through a 'community of practice' lens.

BACKGROUND: The recent UK Government paper 'Five year forward view' describes the need to move much patient management from secondary to primary care, and this will require a significant increase in the numbers of General Practice Nurses (GPNs). Until recently, there has been no clear recruitment strategy to address this. There have however been a number of proposed solutions to address the impending GPN recruitment crisis and to increase the numbers of new GPNs in post. General Practitioners (GPs) working in the Advanced Training Practice Scheme (ATPS) have been commissioned by Health Education England to provide placements for student nurses. This paper reports upon the findings of a study evaluating the South Yorkshire ATPS network in relation to nursing students' perceptions of general practice as a placement and a potential career option post-graduation. METHODS: Data were collected using semi-structured interviews with 18 nursing students. Qualitative data analysis used a framework approach and themes were cross-checked within the team. The research had ethical approval and anonymity and confidentiality were maintained throughout. RESULTS: Using the Communities of Practice (CoP) framework as a theoretical lens, two main themes emerged from the data: 'Myths and misunderstandings' outlined some of the misconceptions that abounded in the absence of an established CoP in general practice. These included perceptions of what constitutes a 'good' placement, an apparent lack of relevant content in the curriculum, and the widespread use of social media by students as a means of information gathering. 'Changing hearts and minds' referred to the need to positively influence the culture within general practice by addressing some of the longstanding myths. Through the fledgling CoP, the students' perceptions of the GPN role in particular were positively revised, as was the prospect of a career in general practice upon graduation. CONCLUSIONS: The CoP that is emerging through the ATPS placements appear to be gradually changing the socio-cultural landscape within general practice by enabling student nurses to experience the reality of life in general practice nursing, and to view the GPN role as a viable career option upon graduation.

Factors affecting decisions to extend access to primary care: results of a qualitative evaluation of general practitioners' views.

OBJECTIVES: To report general practitioners' (GPs') views and experiences of an Enhanced Primary Care programme (EPCP) funded as part of the Prime Minister's Challenge Fund (second wave) for England which aimed to extend patient access to primary care. SETTING: Primary care in Sheffield, England. PARTICIPANTS: Semi-structured interviews with a purposive sample of GPs working in 24 practices across the city. RESULTS: Four core themes were derived: GPs' receptivity to the aims of the EPCP, their capacity to support integrated care teams, their capacity to manage urgent care and the value of some new community-based schemes to enhance locality-based primary care. GPs were aware of the policy initiatives associated with out-of-hours access that aimed to reduce emergency department and hospital admissions. Due to limited capacity to respond to the programme, they selected elements that directly related to local patient demand and did not increase their own workload. CONCLUSIONS: The variation in practice engagement and capacity to manage changes in primary care services warrants a subtle and specialist approach to programme planning. The study makes the case for enhanced planning and organisational development with GPs as stakeholders within individual practices and groups. This would ensure that policy implementation is effective and sustained at local level. A failure to localise implementation may be associated with increased workloading in primary care without the sustained benefits to patients and the public. To enable GPs to become involved in systems transformation, further research is needed to identify the best methods to engage GPs in programme planning and evaluation.

Evaluation of a mental health liaison team. Part 2: the themes and their effect on practice.

Hospitals and emergency departments (EDs) are caring for increasing numbers of patients who present with underlying mental health issues. Managing these patients can be challenging for clinical staff who often lack the specialist knowledge and skills required to provide appropriate care. This article, part two of two on the evaluation of a newly formed mental health liaison team (MHLT) working in a general hospital, focuses on the perceptions and experiences of the MHLT participants, and explores three sub-themes derived from the interview data. The article considers the effect of these themes on practice, and the relationship between MHLT members and staff in EDs and the wider hospital.

Evaluation of a mental health liaison team. Part 1: background and literature review.

Hospitals and emergency departments (EDs) are caring for increasing numbers of patients who present with underlying mental health issues. Management of these patients can be challenging for clinical staff who often lack the specialist knowledge and skills required to provide appropriate care. In April 2015, a mental health liaison service was introduced in Rotherham Hospital as part of a two-year pilot scheme. The aim was to provide assessment and treatment of adults with mental health problems admitted to the hospital. An evaluation of the new service was undertaken to assess the effects of the service. This article, part one of two, reviews the literature, as well as outlining the background to, and method of, evaluation. Part two, which will be published in December, examines the themes revealed by analysis of the service participants' responses.

Education for healthcare clinical support workers.

This article reviews the current situation regarding the provision of education and training for healthcare clinical support workers (HCSWs). In the UK, there has been an increasing reliance on unqualified clinical support staff to provide a significant proportion of the direct patient care in all healthcare settings. HCSWs routinely undertake several nursing activities that were traditionally the responsibility of nursing students or junior staff nurses. There is a need for an urgent review of the training of healthcare support staff. A 'tick box' approach to training, with an emphasis on classroom-based or on-the-job learning, makes it difficult for HCSWs to integrate theory into practice, and supports a transactional approach to caring rather than a relational approach to caregiving. Lessons from the educational experiences of other healthcare groups should be applied to the training of HCSWs. An immersive, participatory teaching and learning strategy is one approach that could be used.

Lessons learned from England's Health Checks Programme: using qualitative research to identify and share best practice.

BACKGROUND: This study aimed to explore the challenges and barriers faced by staff involved in the delivery of the National Health Service (NHS) Health Check, a systematic cardiovascular disease (CVD) risk assessment and management program in primary care. METHODS: Data have been derived from three qualitative evaluations that were conducted in 25 General Practices and involved in depth interviews with 58 staff involved all levels of the delivery of the Health Checks. Analysis of the data was undertaken using the framework approach and findings are reported within the context of research and practice considerations. RESULTS: Findings indicated that there is no 'one size fits all' blueprint for maximising uptake although success factors were identified: evolution of the programme over time in response to local needs to suit the particular characteristics of the patient population; individual staff characteristics such as being proactive, enthusiastic and having specific responsibility; a supportive team. Training was clearly identified as an area that needed addressing and practitioners would benefit from CVD specific baseline training and refresher courses to keep them up to date with recent developments in the area. However there were other external factors that impinged on an individual's ability to provide an effective service, some of these were outside the control of individuals and included cutbacks in referral services, insufficient space to run clinics or general awareness of the Health Checks amongst patients. CONCLUSIONS: The everyday experiences of practitioners who participated in this study suggest that overall, Health Check is perceived as a worthwhile exercise. But, organisational and structural barriers need to be addressed. We also recommend that clear referral pathways be in place so staff can refer patients to appropriate services (healthy eating sessions, smoking cessation, and exercise referrals). Local authorities need to support initiatives that enable data sharing and linkage so that GP Practices are informed when patients take up services such as smoking cessation or alcohol harm reduction programmes run by social services.

Stress and type 2 diabetes: a review of how stress contributes to the development of type 2 diabetes.

Current policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if (a) the PSR to psychosocial factors (especially social disparities) was recognized and (b) intervention programs evaluated reduction in social disparities as part of a comprehensive approach.

Socioeconomic status and the risk of depression among U.K. higher education students.

BACKGROUND: Many university students experience some symptoms of depression during the course of their studies but there is evidence that students from less advantaged backgrounds may be more vulnerable. METHODS: The study was a cross-sectional online survey of 923 undergraduate students attending 6 U.K. Universities in the academic year 2009-2010 who completed a modified version of the Zagazig Depression Scale (ZDS). RESULTS: Overall, 58.1% of female and 59.9% of male study participants screened positive for depression (ZDS score >10). In the fully adjusted model, final year students (OR = 1.8) who lived in a more deprived area (OR = 2.3) were more likely to report higher rates of depressive symptoms. Additionally, students with high perceived control (OR = 1.6) whose mothers were highly educated (OR = 0.5) and from a family of a high affluence (OR = 0.3) were less likely to suffer from higher rates of depressive symptoms. The relationship between lower social economic status and depression was partly mediated by low sense of control. CONCLUSION: Students from less advantaged backgrounds are more at risk of depression but a strong sense of control over one's life may be protective. APPLICATION: Since depression has strong impact on students' learning and quality of life universities should consider confidential screening for mental health problems and provide additional support for students.

A systematic review of studies of depression prevalence in university students.

BACKGROUND: Depression is a common health problem, ranking third after cardiac and respiratory diseases as a major cause of disability. There is evidence to suggest that university students are at higher risk of depression, despite being a socially advantaged population, but the reported rates have shown wide variability across settings. PURPOSE: To explore the prevalence of depression in university students. METHOD: PubMed, PsycINFO, BioMed Central and Medline were searched to identify studies published between 1990 and 2010 reporting on depression prevalence among university students. Searches used a combination of the terms depression, depressive symptoms, depressive disorders, prevalence, university students, college students, undergraduate students, adolescents and/or young adults. Studies were evaluated with a quality rating. RESULTS: Twenty-four articles were identified that met the inclusion and exclusion criteria. Reported prevalence rates ranged from 10% to 85% with a weighted mean prevalence of 30.6%. CONCLUSIONS: The results suggest that university students experience rates of depression that are substantially higher than those found in the general population. Study quality has not improved since 1990.

The living with dysarthria group: implementation and feasibility of a group intervention for people with dysarthria following stroke and family members.

BACKGROUND: The broad life implications of acquired dysarthria are recognized, but they have received little attention in stroke management. Reports of group therapy, which may be a suitable approach to intervention, are not available for stroke-related dysarthria. AIMS: To examine the operational feasibility of and response to a new eight-session weekly group intervention programme, Living with Dysarthria, designed for people with chronic dysarthria following stroke and their main communication partners. METHODS & PROCEDURES: The target participation was for programme completion by two groups of eight people with dysarthria (PWD) and available family members (FMs) or carers. An active recruitment strategy was undertaken from the speech and language therapy case records for the previous 6 years in two hospitals with combined annual stroke admissions of over 500 people. Twelve PWD and seven FMs were recruited (group 1: seven PWD and four FMs; group 2: five PWD and three FMs). Speech intelligibility, communication effectiveness, general well-being, quality of communication life, and knowledge of stroke and dysarthria were assessed pre- and post-programme. Each PWD and FM also set an individual goal and rated their achievement of this on a 0-10 scale. OUTCOMES & RESULTS: Recruitment to the programme was lower than anticipated and below target. The 12 PWD were recruited from 62 initial contacts, which was the total number who according to available information met the criteria. The programme was viable: it ran to plan, with only minor content alterations, in community accommodation, and with good participant engagement. Group median score changes were in a positive direction for all measures and effect sizes ranged from 0.17 (quality of communication life) to 0.46 (intelligibility). Significant post-programme changes were present for intelligibility and knowledge of stroke and dysarthria (p= 0.05). Participants' ratings of goal achievements ranged from 6 (some change) to 10 (a lot of change). CONCLUSIONS & IMPLICATIONS: The recruitment experience revealed a take-up rate of around 20% from PWD following stroke, informing future planning. The participant engagement and performance results from the piloting of the programme indicate that the Living with Dysarthria programme is viable and has potential for effecting positive change. Further testing is justified.

Analysis of an Egyptian study on the socioeconomic distribution of depressive symptoms among undergraduates.

BACKGROUND: Worldwide population surveys show that prevalence of mental disorders in developing countries was as common as in industrialized countries. College life is an important stage in every person's life; unfortunately, it may be the time to experience depression for the first time. Latterly, there has been a steady increase in the number of university students diagnosed and treated as depressed patients. This paper presents the results of a study carried out on a representative sample of undergraduate students of an Egyptian University, which aimed to study the relationship between social factors and the occurrence of depression. It was assumed that the poorer the socio-economic background the higher the rates of depression. METHOD: Data were collected in 2004 from students at Assiut University using the Zagazig Depression scale (ZDS) and an Egyptian socio-economic status measure. This analysis, based on a refined version of the ZDS used STATA (v. 10.1.). Descriptive statistics, univariate and multivariate regression models were used to test for associations with the dimensions of SES and depression. RESULT: Thirty-seven percent of the students had symptoms scored above the threshold for moderate depression. In the fully adjusted model: faculty of study, father's occupation, family income and number of persons per room were associated with depression in this sample. CONCLUSION: The high prevalence of depressive symptoms among Egyptian students found in this study call attention to the need for a student counseling service offering mental health support. This service should particularly discover an approach for low affluence students.