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Huynh E, Wiley E, Park S, Sakakibara BM, Tang A. Examining the association between balance self-efficacy and virtual balance performance in individuals with stroke: a cross-sectional study. Top Stroke Rehabil 2024:1-9. [PMID: 38785298 DOI: 10.1080/10749357.2024.2356407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Balance self-efficacy is a strong predictor of fall risk after stroke and is related to performance on balance and walking tests. The use of telerehabilitation for delivering stroke rehabilitation has increased in recent years and there is a need to adapt common clinical assessments to be administered in virtual formats, but the association between balance self-efficacy and virtually administered clinical tests of balance performance has yet to be established. This study examined the association between the Activities-specific Balance Confidence (ABC) Scale and virtually administered Timed Up and Go (TUG), Tandem Stand, and Functional Reach tests (FRT) in individuals with stroke. METHODS This was a secondary analysis of baseline data from two telerehabilitation trials with individuals with stroke. All assessments were administered by trained physical therapists through videoconferencing software. Multivariate regression analyses were used to examine the associations between the ABC scale and TUG test, Tandem Stand test, and FRT, adjusted for age and number of comorbidities. RESULTS Data from 51 participants (n = 11 female, median age = 64 [IQR: 18] years, 9.3 ± 4.6 months poststroke) were analyzed. The ABC scores were associated with TUG (R2 = 0.56, F(3,47) = 20.26, p < 0.01), but not Tandem Stand (R2 = 0.18, F(5,45) = 1.93, p = 0.11) or FRT (R2 = 0.14, F(3,47) = 2.55, p = 0.07) tests. CONCLUSION We observed associations between the ABC scores and virtual TUG, but not with Tandem Stand or FRT, which may be attributed to the context-specificity of balance self-efficacy. As virtual administration of outcomes assessments becomes part of common practice in stroke rehabilitation, our study supports the use of virtually administered TUG in stroke.
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Affiliation(s)
- Eric Huynh
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Elise Wiley
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Sarah Park
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, The University of British Columbia, Kelowna, Canada
| | - Brodie M Sakakibara
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, The University of British Columbia, Kelowna, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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2
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Allison BA, Yates L, Tadikonda A, Arora KS, Stuart GS. Single-Visit Long-Acting Reversible Contraception Initiation Among Adolescents Before and During COVID-19. J Adolesc Health 2024; 74:367-374. [PMID: 37815761 PMCID: PMC10810361 DOI: 10.1016/j.jadohealth.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Single-visit long-acting reversible contraception (LARC) is cost-effective and convenient. Our objective was to compare incidence of single-visit LARC placement and associated factors during the year before the COVID-19 pandemic (March 15, 2020) and the first year of the pandemic. METHODS This retrospective cohort study analyzed electronic health records from a large healthcare system. Eligible adolescents were aged 10-19 years and received outpatient LARC from March 15, 2019 to March 14, 2021. Logistic regression models determined the relationship of patient and provider characteristics on single-visit LARC before and during COVID-19. RESULTS One thousand six adolescents initiated LARC during the study period. Fewer adolescents received single-visit LARC during COVID-19 (289/506, 57.1%) compared to before (315/500, 63.0%), although changes in odds of single-visit LARC were not statistically significant. Concordance between county of patient residence and the location of the LARC placement facility was associated with single-visit LARC before (adjusted odds ratio [aOR] = 2.75) and during (aOR = 1.74) the pandemic (both p < .05). During the pandemic, a few factors were associated with reduced odds of single-visit LARC: (1) public insurance (aOR = 0.49, p < .01), (2) nonobstetricians/nongynecologists providers (pediatrics [aOR = 0.35, p < .01], family medicine [aOR = 0.53, p < .01], or internal medicine [aOR = 0.14, p < .05]), and (3) advanced practice practitioners (aOR = 0.49, p < .01). DISCUSSION Incidence of single-visit LARC was similar before and during the pandemic. Certain factors were associated with lower odds of single-visit LARC insertion, suggesting differential access during the pandemic for subgroups of adolescents. Our findings may guide policy and programmatic interventions to improve access to single-visit LARC for all adolescent populations.
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Affiliation(s)
- Bianca A Allison
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Lindsey Yates
- Department of Maternal and Child Health, Center of Excellence, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Ananya Tadikonda
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Gretchen S Stuart
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Amill-Rosario A, Rose R, dosReis S. Impact of Private Payer Policies on the Transition to Telemental Health Care Among Privately Insured Patients with Mental Health Disorders. Telemed J E Health 2024; 30:260-267. [PMID: 37432791 DOI: 10.1089/tmj.2023.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Introduction: Mental health patients in states without private payer telehealth reimbursement policies before the public health emergency (PHE) may have experienced reduced access to telemental health (TMH). We estimate the association between private payer telehealth policy status in 2019 and the transition to TMH in 2020. Methods: Retrospective cohort study of privately insured individuals 2-64 years old with a mental health disorder and without TMH use in 2019. We examined new telemental use in 2020 by three categories of policy reimbursement status in 2019 (partial parity, full parity vs. no policy), overall (any telemental), and by modality (live video, audio-only, and online assessments) using logistic regression models clustered by state. Results: Among the 34,612 enrollees, 54.7% received TMH for the first time. Relative to no policy states, enrollees in partial or full parity states were equally likely to receive TMH in 2020. However, enrollees in states with a private payer telehealth policy were less likely to receive audio-only (partial parity: odds ratio [OR]: 0.59, 95% confidence interval [CI]: 0.39-0.90; full parity: OR: 0.38, 95% CI: 0.26-0.55), but more likely to receive online assessments (full parity: OR: 2.28, 95% CI: 1.4-4.59). Conclusions: Privately insured enrollees similarly transitioned to TMH across states suggesting a broad impact of the PHE policies on access to this care. The differences in audio-only and online assessments suggest that providers were possibly better prepared to implement TMH care via live video or patient portals in states with telehealth policies.
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Affiliation(s)
- Alejandro Amill-Rosario
- Department of Pharmaceutical Science and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Roderick Rose
- School of Social Work, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Susan dosReis
- Department of Pharmaceutical Science and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland, USA
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Thakkar PV, Scott Z, Hoffman M, Delarosa J, Hickerson J, Boutzoukas AE, Benjamin DK, Brookhart MA, Zimmerman KO, Moorthy GS. Impact of the COVID-19 Pandemic on Pediatric Preventive Health Care Among North Carolina Children Enrolled in Medicaid. J Pediatric Infect Dis Soc 2023; 12:S14-S19. [PMID: 38146859 PMCID: PMC10750309 DOI: 10.1093/jpids/piad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Children enrolled in private insurance had reduced preventive health care during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the pandemic on children enrolled in Medicaid has been minimally described. METHODS We used an administrative claims database from North Carolina Medicaid to evaluate the rates of well-child visits and immunization administration for children ≤14 months of age, and used a quasi-Poisson regression model to estimate the rate ratio (RR) of each outcome during the pandemic period (3/15/2020 through 3/15/2021) compared with the pre-pandemic period (3/15/2019 through 3/14/2020). RESULTS We included 83 442 children during the pre-pandemic period and 96 634 children during the pandemic period. During the pre-pandemic period, 405 295 well-child visits and 715 100 immunization administrations were billed; during the pandemic period, 287 285 well-child visits and 457 144 immunization administrations were billed. The rates of well-child visits (RR 0.64; 95% CI, 0.64-0.64) and vaccine administration (RR 0.55; 95% CI, 0.55-0.55) were lower during the pandemic compared with the pre-pandemic period. CONCLUSIONS The rates of well-child visits and immunization administrations among North Carolina children enrolled in public insurance substantially decreased during the first year of the COVID-19 pandemic.
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Affiliation(s)
- Pavan V Thakkar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zeni Scott
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Molly Hoffman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jesse Delarosa
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jesse Hickerson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Angelique E Boutzoukas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - M Alan Brookhart
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kanecia O Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ganga S Moorthy
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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Park JH, Lee MJ, Tsai MH, Shih HJ, Chang J. Rural, Regional, Racial Disparities in Telemedicine Use During the COVID-19 Pandemic Among US Adults: 2021 National Health Interview Survey (NHIS). Patient Prefer Adherence 2023; 17:3477-3487. [PMID: 38143946 PMCID: PMC10749101 DOI: 10.2147/ppa.s439437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The primary objective of this study is to conduct a comparative analysis of telemedicine utilization patterns among adult populations residing in both rural and urban areas and evaluate the probability of telemedicine adoption among adults dwelling in both rural and urban areas amid the backdrop of the COVID-19 pandemic. Methods Our study has attained sample populations (n = 279,260, National Weighted Estimates = 2,391,188,373) through the secondary analysis of the National Health Interview Survey (NHIS) for the year 2021. We examined the relationship between the rural, regional, and racial variables using chi-square tests and binary logistic regression associated with telemedicine use in our multivariable analysis. Results Telemedicine use by population decreased with decreasing urbanization level, from 40.2% among adults living in large central metropolitan to 29.7% among adults living in rural area (p<0.0001). Regarding household income, adults with 400% or more of the federal poverty level (FPL) were significantly more likely to use telemedicine than adults with less than 100% of the FPL. Females were more likely than males to utilize telemedicine. In terms of region, adults living in the West were 1.25 times more likely to use telemedicine than adults living in the Northeast, and minority race/ethnicity groups (eg, Non-Hispanic Black, Hispanic, and other) are less likely to use the telemedicine rather than Non-Hispanic White. Conclusion Health equity is attained when all demographic groups enjoy uniform access to healthcare services, but disparities emerge when there are discernible variations in access to treatment. Considering this study's findings, it becomes evident that the distinctions in poverty rates, median income levels, and healthcare utilization patterns across racial and regional lines may serve as indicators of potential health equity concerns.
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Affiliation(s)
- Jeong-Hui Park
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Min Jee Lee
- Population Science and Policy, School of Medicine, Southern Illinois University, Springfield, IL, USA
| | - Meng-Han Tsai
- Georgia Prevention Institute, Augusta University, Augusta, GA, USA
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Huan-Ju Shih
- Department of Health Administration and Policy, School of Public Health, George Mason University, Fairfax, VA, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA
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Sangra S, Razdan N, Gupta S, Dwivedi N. A Study on Community needs, perceptions and demand regarding the use of the health services during COVID-19 pandemic in district Kathua, J and K. J Family Med Prim Care 2023; 12:3092-3097. [PMID: 38361910 PMCID: PMC10866272 DOI: 10.4103/jfmpc.jfmpc_2145_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 02/17/2024] Open
Abstract
Introduction The impact of the COVID-19 pandemic on essential health services is a source of great concern. Health gains made during the last 2-3 decades have been halted due to shifting of resources to fight the COVID-19 pandemic. Aim and Objective This study was conducted to identify community needs, demands, and perceptions regarding the effectiveness of using health services during the pandemic. Methodology This was a qualitative study which was conducted through focus group discussions. The participants comprised of three groups: community leaders, healthcare providers, and field workers. Discussion among the participants was conducted using the standardized World Health Organization community assessment tool. Result In our study, it was reported that most of the essential health services were disrupted due to COVID-19 pandemic. The barriers to accessing essential health services have been exacerbated and the provision of community-based services is effected due to this. In regard to COVID-19 vaccination also, there remain individuals who are reluctant to be vaccinated. Conclusion Our study shows that the community faced barriers in accessing and using health services during the pandemic. To ensure the public's access to health services and strengthen healthcare preparedness strategies like health budget allocation, manpower, infrastructure, trainings, integration with primary healthcare, etc., need to be carried out during and after the pandemic. Thus, participation and inter-sectoral coordination across levels are required to overcome these barriers.
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Affiliation(s)
- Sonika Sangra
- Department of Community Medicine, GMC Kathua, Jammu and Kashmir, India
| | - Nazuk Razdan
- Department of Community Medicine, GMC Udhampur, Jammu and Kashmir, India
| | - Sujata Gupta
- Department of Community Medicine, GMC Kathua, Jammu and Kashmir, India
| | - Nidhi Dwivedi
- Department of Community Medicine, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
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Gomezelj MC, Miroševič Š, Tajki AV, Bunc KT, Van Poel E, Willems S, Klemenc-Ketiš Z. The safety of patient management in family medicine in Slovenia during Covid-19: a cross-sectional study. BMC PRIMARY CARE 2023; 24:255. [PMID: 38031008 PMCID: PMC10687777 DOI: 10.1186/s12875-023-02209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND During the Covid-19 pandemic, family medicine practices (FMPs) changed to improve safety against new coronavirus infections for both patients and employees. Protocols for treating patients with suspected Sars-Cov-2 infections were established to protect medical staff and other patients from being infected. However, these protocols also led to increased safety risks, such as delays in treating patients with other medical conditions. This exploratory study aimed to investigate safety risks in treating patients in FMPs during the Covid-19 pandemic and to suggest improvements to prevent Covid-19 in FMPs in Slovenia. METHODS A cross-sectional study was rolled out in FMPs in Slovenia as part of the international Pricov-19 study. Data collection on safety management during the Covid-19 pandemic in FMPs in Slovenia took place from November 2020 until January 2021 using a self-administered online survey for FP working in Slovenia. A chi-square test, ANOVA, independent samples t-test or bivariate correlation test was performed to explore associations regarding the safety of patients' management variables. RESULTS From the 191 participating family physicians (FPs) (15.2% response rate), 54.8% reported having treated patients with fever (not Covid-19) late due to the new protocols at least once, and 54.8% reported patients with urgent conditions having been seen late at least once due to not coming. In the suburbs and rural environments FPs more often reported that at least once patient with a fever (not Covid-19) was seen late due to the protocol (p = 0.017) and more often reported that at least once patient with an urgent condition was seen late due to not coming to their FP (p = 0.017). The larger the practice, the more they reported that at least once a patient with fever (not Covid-19) was seen late due to the protocol (p = 0.012) and the more they reported at least once a patient with an urgent condition was seen late due to not coming to their FP (p = 0.012). CONCLUSION Covid-19 affected the safety of patient management in FMP in Slovenia. The most common problem was foregone care. Therefor, protocols for chronic patient management in the event of epidemics need to be established.
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Affiliation(s)
- Maja Cvetko Gomezelj
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Špela Miroševič
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Alina Verdnik Tajki
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Ksenija Tušek Bunc
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Zalika Klemenc-Ketiš
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
- Ljubljana Community Health Centre, Ljubljana, Slovenia
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Javvaji CK, Vagha JD, Meshram RJ, Taksande A. Assessment Scales in Cerebral Palsy: A Comprehensive Review of Tools and Applications. Cureus 2023; 15:e47939. [PMID: 38034189 PMCID: PMC10685081 DOI: 10.7759/cureus.47939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
Cerebral palsy (CP) is a complex neurological condition characterized by motor dysfunction affecting millions worldwide. This comprehensive review delves into the critical role of assessment in managing CP. Beginning with exploring its definition and background, we elucidate the diverse objectives of CP assessment, ranging from diagnosis and goal setting to research and epidemiology. We examine standard assessment scales and tools, discuss the challenges inherent in CP assessment, and highlight emerging trends, including integrating technology, personalized medicine, and neuroimaging. The applications of CP assessment in clinical diagnosis, treatment planning, research, and education are underscored. Recommendations for the future encompass standardization, interdisciplinary collaboration, research priorities, and professional training. In conclusion, we emphasize the importance of assessment as a compass guiding the care of individuals with CP, issuing a call to action for improved assessment practices to shape a brighter future for those affected by this condition.
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Affiliation(s)
- Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayant D Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Karkon S, O'Shea F, Doran M, McCormack H, Connolly D. Testing the feasibility and acceptability of an online 'Fatigue and Activity Management Education for Work (FAME-W) programme' for individuals with inflammatory arthritis. Musculoskeletal Care 2023; 21:815-826. [PMID: 36929565 DOI: 10.1002/msc.1756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Fatigue and Activity Management Education for Work (FAME-W) is a four-week, occupational therapy led programme focussing on fatigue management strategies. FAME-W was designed to be delivered in person; however, due to COVID-19 pandemic it was modified to be an online group-based self-management intervention. The purpose of this study was to test the feasibility and acceptability of the online delivery format of FAME-W. METHODS This was a mixed methods study. Participants were randomly allocated to intervention or control group. Participants in the intervention group received a four-week online FAME-W. The control group participants received a FAME-W handbook. Participants were required to complete questionnaires on work presenteeism, fatigue, mood, Health Related Quality of Life and pain at baseline, and 3 months post-intervention. Participants in the intervention group attended a focus group immediately following the completion of the programme and the control group participated in individual interviews. RESULTS Seven of ten individuals recruited participated in the study. Majority of participants had Rheumatoid Arthritis and were working full-time. The mean age of intervention participants was 53 ± 10.4 and 56.5 ± 3.7 for the controls. All participants in the intervention group had 100% attendance, completed all study measures and activities. Participants had positive comments about the programme format, content, and delivery. Improvements were observed in most measures at follow up. CONCLUSION Results suggest that an online programme to improve work ability was feasible and acceptable to individuals with inflammatory arthritis. The online delivery format was favoured over attending a centre-based programme. The findings support a definitive intervention trial of online FAME-W.
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Affiliation(s)
- Shalaleh Karkon
- Discipline of Occupational Therapy, Trinity Centre for Health Sciences, St James' Hospital, Dublin, Ireland
| | - Finbar O'Shea
- Rheumatology Department, St James' Hospital, Dublin, Ireland
| | - Michelle Doran
- Rheumatology Department, St James' Hospital, Dublin, Ireland
| | - Hazel McCormack
- Occupational Therapy Department, St James' Hospital, Dublin, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity Centre for Health Sciences, St James' Hospital, Dublin, Ireland
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Saharoy R, Potdukhe A, Wanjari M, Taksande AB. Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants. Cureus 2023; 15:e41381. [PMID: 37546054 PMCID: PMC10400812 DOI: 10.7759/cureus.41381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Postpartum depression (PPD) is a common and debilitating mental health condition affecting many mothers worldwide. This review article aims to explore the complex effects of PPD on mothers and infants, focusing on maternal care. The transition to motherhood is a critical period characterized by numerous physical, psychological, and social changes, making women vulnerable to the onset of PPD. Consequently, PPD can significantly impact a mother's ability to provide optimal care for her infant, leading to potential adverse consequences for both parties. The article synthesizes existing research literature on the topic, encompassing studies from various disciplines, including psychology, psychiatry, obstetrics, and pediatrics. It begins by providing an overview of the prevalence and risk factors associated with PPD, emphasizing the importance of early detection and intervention. The impact of PPD on maternal caregiving behaviors, such as bonding, sensitivity, and responsiveness, is then examined, highlighting the potential disruptions in the mother-infant relationship. Furthermore, the article delves into the potential consequences of impaired maternal care on infant development, including emotional, cognitive, and social domains. Several factors contributing to the complex interplay between PPD and maternal care are discussed, including hormonal changes, psychosocial stressors, and the influence of social support networks. The review also addresses the bidirectional nature of the mother-infant relationship, whereby infant characteristics and behaviors can exacerbate or mitigate the effects of PPD on maternal care. Moreover, the article explores the role of healthcare providers and the importance of implementing effective screening, assessment, and treatment strategies for PPD to promote optimal maternal-infant outcomes. By consolidating current knowledge on the topic, this review article provides valuable insights into the multifaceted effects of PPD on both mothers and infants. Recognizing the significance of maternal care and understanding the mechanisms through which PPD disrupts it can inform the development of targeted interventions to promote early detection, effective treatment, and supportive interventions for mothers experiencing PPD. Ultimately, improving maternal mental health and enhancing maternal-infant relationships can yield long-term positive effects on mothers' and infants' well-being and development.
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Affiliation(s)
- Rishika Saharoy
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashwini Potdukhe
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Avinash B Taksande
- Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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11
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Hicks PM, Kang L, Armstrong ML, Pongrac JR, Stagg BC, Saylor KM, Newman-Casey PA, Woodward MA. A scoping review of patients' barriers to eye care for glaucoma and keratitis. Surv Ophthalmol 2023; 68:567-577. [PMID: 37004793 PMCID: PMC10875963 DOI: 10.1016/j.survophthal.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
In this scoping review, we examine underlying causes of loss to follow-up for chronic (glaucoma) and acute (corneal ulcers) eye conditions using the Penchansky and Thomas access to care framework. We explore barriers by World Health Organization income levels and by studying geographical location. We identified 6,363 abstracts, with 75 articles retrieved and 16 meeting inclusion criteria. One article discussed barriers to follow-up care for people with corneal ulcers, and the other 15 were for people with glaucoma. The most frequent barriers to care were affordability, awareness, and accessibility. The international studies had a greater percentage of studies report acceptability as a barrier to loss to follow-up. Countries with universal healthcare included affordability as a loss to follow-up barrier, emphasizing that cost goes beyond the ability to pay for direct treatment costs. Understanding and addressing barriers to follow-up care can aid the goal of continued care and decrease the risk of poor outcomes and vision loss.
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Affiliation(s)
- Patrice M Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Linda Kang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | | | - Joseph R Pongrac
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Brian C Stagg
- John Moran Eye Center, University of Utah, Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Kate M Saylor
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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Liu W, Li J, Dalton CM. Disruptions to in-person medical visits across the United States during the COVID-19 pandemic: evolving disparities by medical specialty and socio-economic status. Public Health 2023; 221:116-123. [PMID: 37441995 PMCID: PMC10250151 DOI: 10.1016/j.puhe.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES This study aimed to investigate how people's health-seeking behaviors evolve in the COVID-19 pandemic by community and medical service category. STUDY DESIGN This is a longitudinal study using mobility data from 19 million mobile devices of visits to all types of health facility locations for all US states. METHODS We examine the variations in weekly in-person medical visits across county, neighborhood, and specialty levels. Different regression models are used for each level to investigate factors that influence the disparities in medical visits. County-level analysis explores associations between county medical visit patterns, political orientation, and COVID-19 infection rate. Neighborhood-level analysis focuses on neighborhood socio-economic compositions as potential determinants of medical visit levels. Specialty-level analysis compares the evolution of visit disruptions in different specialties. RESULTS A more left-leaning political orientation and a higher local infection rate were associated with larger decreases in in-person medical visits, and these associations became stronger, moving from the initial period of stay-at-home orders into the post-lockdown period. Initial reactions were strongest for seniors and those of high socio-economic status, but this reversed in post-lockdown period where socio-economically disadvantaged communities stabilized at a lower level of medical visits. Neighborhoods with more female and young people exhibited larger decreases in in-person medical visits throughout the initial and post-lockdown periods. The evolution of disruptions diverges across medical specialties, from only short-term disruption in specialties such as dentistry to increasing disruption, as in cardiology. CONCLUSIONS Given distinct patterns in visit between communities, medical service categories, and between different periods in the pandemic, policy makers, and providers should concentrate on monitoring patients in disrupted specialties who overlap with the at-risk contexts and socio-economic factors in future health emergencies.
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Affiliation(s)
- W Liu
- Department of Industrial Engineering, Tsinghua University, Beijing 100084, China.
| | - J Li
- School of Business, Wake Forest University, Winston-Salem, NC 27106, United States.
| | - C M Dalton
- Department of Economics, Wake Forest University, Winston-Salem, NC 27106, United States.
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13
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De Leo AN, Giap F, Culbert MM, Drescher N, Brisson RJ, Cassidy V, Augustin EM, Casper A, Horowitz DH, Cheng SK, Yu JB. Nationwide changes in radiation oncology travel and location of care before and during the COVID-19 pandemic. Radiat Oncol J 2023; 41:108-119. [PMID: 37403353 PMCID: PMC10326508 DOI: 10.3857/roj.2023.00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 07/06/2023] Open
Abstract
PURPOSE Patients with cancer are particularly vulnerable to coronavirus disease (COVID). Transportation barriers made travel to obtain medical care more difficult during the pandemic. Whether these factors led to changes in the distance traveled for radiotherapy and the coordinated location of radiation treatment is unknown. MATERIALS AND METHODS We analyzed patients across 60 cancer sites in the National Cancer Database from 2018 to 2020. Demographic and clinical variables were analyzed for changes in distance traveled for radiotherapy. We designated the facilities in the 99th percentile or above in terms of the proportion of patients who traveled more than 200 miles as "destination facilities." We defined "coordinated care" as undergoing radiotherapy at the same facility where the cancer was diagnosed. RESULTS We evaluated 1,151,954 patients. There was a greater than 1% decrease in the proportion of patients treated in the Mid-Atlantic States. Mean distance traveled from place of residence to radiation treatment decreased from 28.6 to 25.9 miles, and the proportion traveling greater than 50 miles decreased from 7.7% to 7.1%. At "destination facilities," the proportion traveling more than 200 miles decreased from 29.3% in 2018 to 24% in 2020. In comparison, at the other hospitals, the proportion traveling more than 200 miles decreased from 1.07% to 0.97%. In 2020, residing in a rural area resulted in a lower odds of having coordinated care (multivariable odds ratio = 0.89; 95% confidence interval, 0.83-0.95). CONCLUSION The first year of the COVID pandemic measurably impacted the location of U.S. radiation therapy treatment.
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Affiliation(s)
- Alexandra N. De Leo
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Fantine Giap
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Matthew M. Culbert
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Nicolette Drescher
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Ryan J. Brisson
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Vincent Cassidy
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | | | - Anthony Casper
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - David H. Horowitz
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Simon K. Cheng
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - James B. Yu
- Department of Radiation Oncology, St. Francis Hospital and Trinity Health of New England, Hartford, CT, USA
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14
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Parlindungan F, Sumariyono S, Hidayat R, Wibowo SAK, Ariane A, Damanik J, Araminta AP, Yunita KC. Learning from the COVID-19 pandemic: health care disturbances and telemedicine as an alternative rheumatology practice in Indonesia. BMC Health Serv Res 2023; 23:451. [PMID: 37158873 PMCID: PMC10165285 DOI: 10.1186/s12913-023-09389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/11/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) affects health care services. Our aim was to assess health care disruptions, treatment interruptions, and telemedicine reception regarding autoimmune rheumatic diseases (ARDs) in Indonesia. METHOD A cross-sectional population online-based questionnaire was conducted in Indonesia from September to December 2021. RESULTS A total of 311 ARD patients were included, of whom 81 (26.0%) underwent consultations via telemedicine during the COVID-19 pandemic. The respondents showed increased concern about their susceptibility to COVID-19 (score of 3.9/5). Approximately 81 (26.0%) avoided hospital visits, and 76 (24.4%) stopped taking the medication without medical advice. Respondents' concerns correlated with their social distancing behaviors (p value 0.000, r 0.458). Respondent concerns, behaviors, and blocked access to the hospital during the pandemic were associated with avoiding hospital visits (p value 0.014; 0.001; 0.045; 0.008). Sex was associated with stopping medication (p value 0.005). In multivariate analysis, blocked access and sex remained significant. Approximately 81 (26%) respondents who used telemedicine services during the COVID-19 pandemic as an alternative medical consultation method showed high satisfaction (3.8/5). CONCLUSION Health care disruptions and treatment interruptions were affected by patients' internal and external factors during the COVID-19 pandemic. Telemedicine may be the best option to address barriers to health care access in Indonesia's rheumatology practice during and after the pandemic situation.
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Affiliation(s)
- Faisal Parlindungan
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
- Department of Internal Medicine, University of Indonesia Hospital, Depok, Indonesia.
- Rheumatology Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
| | - Sumariyono Sumariyono
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- Rheumatology Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Rudy Hidayat
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- Rheumatology Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Suryo Anggoro Kusumo Wibowo
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- Rheumatology Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Anna Ariane
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- Rheumatology Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Johanda Damanik
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- Rheumatology Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Abirianty Priandani Araminta
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- Rheumatology Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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15
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Borowski E, Stathopoulos A. Nowhere to go? A study of marginalization, social connection, and mental health outcomes among young adults experiencing the COVID-19 pandemic. JOURNAL OF TRANSPORT & HEALTH 2023; 30:101589. [PMID: 37008981 PMCID: PMC9968624 DOI: 10.1016/j.jth.2023.101589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND The COVID-19 pandemic onset necessitated large-scale closures of third places, potentially exacerbating social barriers experienced by young adults in the United States. To better understand the role of urban form in facilitating socialization, we examine the effects of pandemic-based third place closures on mental health outcomes as mediated by changes in social connection. Because identifying as a racial, gender, or sexual minority can compound baseline disadvantages rooted in systemic inequities, we investigate outcome differences for non-white, woman/nonbinary, and LGBTQ+ young adults to disentangle identity-based nuances of the pandemic experience. METHODS In February 2021, we administered a web-based survey with retrospective name and place generators to 313 18-to-34-year-olds in California, Illinois, and Texas. A structural equation model is estimated showing the direct and indirect effects of physical and virtual mobility constraints on mental health. RESULTS Both the closure of third places and dissatisfaction with alternative social spaces are associated with the deterioration of social connections and mental health. The strongest direct predictor of mental health decline is dissatisfaction with virtual socialization (more significant for women and nonbinary respondents). Surprisingly, two distinct categories of third places (i.e., 'civic' and 'commercial') reveal different relationships with social connections and mental health outcomes. Asian, other non-white, and non-heterosexual young adults experienced greater 'civic' visit reduction, while those with intersecting identities of low income and woman/nonbinary or Black experienced greater 'commercial' visit reduction. CONCLUSIONS Physical and virtual mobility reductions contributed to the inequitable mental health outcomes experienced by young adults during the pandemic. This highlights the potential for a careful redesign of physical and virtual social spaces to support feelings of belonging/safety and spontaneous 'weak tie' interactions, encourages further investigation of social infrastructure's role in facilitating the maintenance of social connections and mental health, and reveals the value of examining differences in mobility-related experiences across social identities.
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Affiliation(s)
- Elisa Borowski
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA
| | - Amanda Stathopoulos
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA
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16
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Lee S, Ko E, Jang K, Kim S. Understanding individual-level travel behavior changes due to COVID-19: Trip frequency, trip regularity, and trip distance. CITIES (LONDON, ENGLAND) 2023; 135:104223. [PMID: 36741336 PMCID: PMC9889257 DOI: 10.1016/j.cities.2023.104223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/16/2022] [Accepted: 01/27/2023] [Indexed: 05/03/2023]
Abstract
Understanding different mechanisms in trip changes depending on transportation modes due to COVID-19 pandemic is the key to providing practical insights for healthy communities. This study aimed to investigate the impact of the COVID-19 pandemic on individual-level travel behavior in Daejeon Metropolitan City, South Korea. Using smart card and private vehicle records, we explored different travel behaviors exhibited while using buses and private vehicles. An individual's travel behavior was represented in trip frequency, trip regularity, and trip distance and was compared weekly for about three months, including the initial period of pandemic. A significant decrease in trip frequency during non-peak hours on weekdays and during weekends indicates that people reduced non-mandatory trips more than commuter trips. This was also verified in that, as the number of infection cases increased, trip regularity with 24-hour intervals intensified. People maintained the size of their activity boundaries but reduced their daily trip distances. The interesting point is that private vehicle usage increased for shorter trip distances while bus usage dropped regardless of the ranges of trip distances under the pandemic. The findings provide evidence of possible inequality issues in transportation during the pandemic and can help make precautionary policies for future pandemics.
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Affiliation(s)
- Sujin Lee
- Cho Chun Shik Graduate School of Mobility, Korea Advanced Institute of Science and Technology, Munji-ro 193, Yuseong-gu, Daejeon 34051, Republic of Korea
| | - Eunjeong Ko
- Cho Chun Shik Graduate School of Mobility, Korea Advanced Institute of Science and Technology, Munji-ro 193, Yuseong-gu, Daejeon 34051, Republic of Korea
| | - Kitae Jang
- Cho Chun Shik Graduate School of Mobility, Korea Advanced Institute of Science and Technology, Munji-ro 193, Yuseong-gu, Daejeon 34051, Republic of Korea
| | - Suji Kim
- Cho Chun Shik Graduate School of Mobility, Korea Advanced Institute of Science and Technology, Munji-ro 193, Yuseong-gu, Daejeon 34051, Republic of Korea
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17
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Sunio V, Carlo Ugay J, Li CW, Joy Liwanag H, Santos J. Impact of public transport disruption on access to healthcare facility and well-being during the COVID-19 pandemic: A qualitative case study in Metro Manila, Philippines. CASE STUDIES ON TRANSPORT POLICY 2023; 11:100948. [PMID: 36619295 PMCID: PMC9810551 DOI: 10.1016/j.cstp.2023.100948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 12/11/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic has forced many governments to halt public transport operations. A consequence of such disruption is the reduction in access to critical facilities by individuals who rely on public transport for their daily mobility. We investigate the impact disparities caused by the restriction of public transportation on the access of healthcare workers and patients to healthcare facilities during the COVID-19 pandemic. Metro Manila is an appropriate case study site because the duration of suspension of public transport in the mega-city is one of the longest in the world. The prolonged duration of the lockdown could have devastating impacts on the well-being of individuals who are reliant on public transport to access essential services. Guided by the Yin-Eisenhardt approach to qualitative research, we examined the data from 55 individuals using within-case and cross-case analyses iteratively for the purpose of building a model on the impact of change in access due to public transport disruption on well-being. We mobilized constructs and concepts known in the literature, such as well-being, access, disruption, resistance, resilience, and vulnerability, in developing our two-step conceptual model. Given the profound impact of the prolonged and system-wide suspension of public transport on the well-being of individuals, it is necessary to provide sufficient public transport and active transport infrastructure and services that can cover their mobility needs. The two-step conceptual model from this study can provide guidance on specific policy interventions.
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Affiliation(s)
- Varsolo Sunio
- Department of Science and Technology - Philippine Council for Industry, Energy, and Emerging Technology Research and Development (DOST-PCIEERD), Taguig City, Philippines
- Department of Science and Technology - National Research Council of the Philippines (DOST-NRCP), Taguig City, Philippines
- Science Engineering and Management Research Institute, University of Asia and the Pacific, Pasig City, Philippines
| | | | | | - Harvy Joy Liwanag
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Health, Manila, Philippines
| | - Jerico Santos
- University of the Philippines-Manila, Ermita, Manila, Philippines
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Ely-Ledesma E, Champagne-Langabeer T. Advancing Access to Healthcare through Telehealth: A Brownsville Community Assessment. Healthcare (Basel) 2022; 10:healthcare10122509. [PMID: 36554033 PMCID: PMC9778105 DOI: 10.3390/healthcare10122509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
(1) Background: This paper focuses on the development of a community assessment for telehealth using an interprofessional lens, which sits at the intersection of public health and urban planning using multistakeholder input. The paper analyzes the process of designing and implementing a telemedicine plan for the City of Brownsville and its surrounding metros. (2) Methods: We employed an interprofessional approach to CBPR which assumed all stakeholders as equal partners alongside the researchers to uncover the most relevant and useful knowledge to inform the development of telehealth community assessment. (3) Results: Key findings include that: physicians do not have the technology, financial means, or staff to provide a comprehensive system for telemedicine; and due to language and literacy barriers, many patients are not able to use a web-based system of telemedicine. We also found that all stakeholders believe that telehealth is a convenient tool that has the capacity to increase patient access and care. (4) Conclusions: Ultimately, the use of an interprofessional community-based participatory research (CBPR) design allowed our team to bring together local knowledge with that of trained experts to advance the research efforts.
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Affiliation(s)
- Edna Ely-Ledesma
- Department of Planning and Landscape Architecture, University of Wisconsin-Madison, Madison, WI 53706, USA
- Correspondence:
| | - Tiffany Champagne-Langabeer
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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19
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Baldomero AK, Kunisaki KM, Wendt CH, Bangerter A, Diem SJ, Ensrud KE, Nelson DB, Henning-Smith C, Bart BA, Hammett P, Hagedorn HJ, Dudley RA. Drive Time and Receipt of Guideline-Recommended Screening, Diagnosis, and Treatment. JAMA Netw Open 2022; 5:e2240290. [PMID: 36331503 PMCID: PMC9636523 DOI: 10.1001/jamanetworkopen.2022.40290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
IMPORTANCE Many patients do not receive recommended services. Drive time to health care services may affect receipt of guideline-recommended care, but this has not been comprehensively studied. OBJECTIVE To assess associations between drive time to care and receipt of guideline-recommended screening, diagnosis, and treatment interventions. DESIGN, SETTING, AND PARTICIPANTS This cohort study used administrative data from the National Veterans Health Administration (VA) data merged with Medicare data. Eligible participants were patients using VA services between January 2016 and December 2019. Women ages 65 years or older without underlying bone disease were assessed for osteoporosis screening. Patients with new diagnosis of chronic obstructive pulmonary disease (COPD) indicated by at least 2 encounter codes for COPD or at least 1 COPD-related hospitalization were assessed for receipt of diagnostic spirometry. Patients hospitalized for ischemic heart disease were assessed for cardiac rehabilitation treatment. EXPOSURES Drive time from each patient's residential address to the closest VA facility where the service was available, measured using geocoded addresses. MAIN OUTCOMES AND MEASURES Binary outcome at the patient level for receipt of osteoporosis screening, spirometry, and cardiac rehabilitation. Multivariable logistic regression models were used to assess associations between drive time and receipt of services. RESULTS Of 110 780 eligible women analyzed, 36 431 (32.9%) had osteoporosis screening (mean [SD] age, 66.7 [5.4] years; 19 422 [17.5%] Black, 63 403 [57.2%] White). Of 281 130 patients with new COPD diagnosis, 145 249 (51.7%) had spirometry (mean [SD] age, 68.2 [11.5] years; 268 999 [95.7%] men; 37 834 [13.5%] Black, 217 608 [77.4%] White). Of 73 146 patients hospitalized for ischemic heart disease, 11 171 (15.3%) had cardiac rehabilitation (mean [SD] age, 70.0 [10.8] years; 71 217 [97.4%] men; 15 213 [20.8%] Black, 52 144 [71.3%] White). The odds of receiving recommended services declined as drive times increased. Compared with patients with a drive time of 30 minutes or less, patients with a drive time of 61 to 90 minutes had lower odds of receiving osteoporosis screening (adjusted odds ratio [aOR], 0.90; 95% CI, 0.86-0.95) and spirometry (aOR, 0.90; 95% CI, 0.88-0.92) while patients with a drive time of 91 to 120 minutes had lower odds of receiving cardiac rehabilitation (aOR, 0.80; 95% CI, 0.74-0.87). Results were similar in analyses restricted to urban patients or patients whose primary care clinic was in a tertiary care center. CONCLUSIONS AND RELEVANCE In this retrospective cohort study, longer drive time was associated with less frequent receipt of guideline-recommended services across multiple components of care. To improve quality of care and health outcomes, health systems and clinicians should adopt strategies to mitigate travel burden, even for urban patients.
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Affiliation(s)
- Arianne K. Baldomero
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Ken M. Kunisaki
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
| | - Chris H. Wendt
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
| | - Ann Bangerter
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Susan J. Diem
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Kristine E. Ensrud
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - David B. Nelson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Division of Biostatistics, University of Minnesota, Minneapolis
| | | | - Bradley A. Bart
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Cardiology, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Patrick Hammett
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Division of Biostatistics, University of Minnesota, Minneapolis
| | - Hildi J. Hagedorn
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - R. Adams Dudley
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
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Graves JM, Abshire DA, Alejandro AG. System- and Individual-Level Barriers to Accessing Medical Care Services Across the Rural-Urban Spectrum, Washington State. Health Serv Insights 2022; 15:11786329221104667. [PMID: 35706424 PMCID: PMC9189527 DOI: 10.1177/11786329221104667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Residents of rural areas face barriers beyond geography and distance when accessing medical care services. The purpose of this study was to characterize medical care access barriers across several commonly used classifications of rurality. Methods: Washington State household residents completed a mixed-mode (paper/online) health care access survey between June 2018 and December 2019 administered to a stratified random sample of ZIP codes classified as urban, suburban, large rural, and small rural (4-tier scheme). For analyses, rurality was also classified into 2-tier schemes (rural/urban) based on ZIP code and county. Respondents reported availability of medical care services and system- and individual-level barriers to accessing services. Logistic regression models estimated the odds of reporting system- or individual-level barriers in accessing medical care services across rurality (4- and 2-tier schemes), adjusting for respondent characteristics, and weighted to account for survey design. Results: About 617 households completed the survey (25.7% response rate). Compared to urban residents (across all 3 schemes), more rural residents reported traveling to a distant city or town for medical care (P < .001). Rurality was significantly associated with increased odds of facing system-level barriers. Respondents from small rural areas had greater odds access barriers for primary care (OR 7.31, 95% CI 1.84-29.09) and having no primary care provider (OR 11.37, 95% CI 3.03-42.75) compared to urban respondents. Individual-level barriers were not associated with rurality. Conclusions: To improve healthcare access across the rural-urban spectrum, policymakers must consider system-level barriers facing rural populations.
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Affiliation(s)
- Janessa M Graves
- College of Nursing, Washington State University, Spokane, WA, USA
| | | | - Art G Alejandro
- College of Nursing, Washington State University, Spokane, WA, USA
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