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The death of a child may be the most traumatic event a family can experience. Bereavement care for parents is essential for their physical and mental well-being and is a psychosocial standard of care. Childhood mortality is higher in low- or middle-income countries (LMICs); however, little is known regarding bereavement support or interventions for parents in LMICs. To identify programs, services, initiatives, or interventions offered to bereaved parents in LMICs in hospital settings. A systematic search was executed following the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles from LMICs describing interventions, programs, or resources provided to parents after the death of a child (0–18 years old) from any cause were included. Extracted data was categorized by demographics, study design, outcomes, and quality assessment using the McGill Mixed Methods Appraisal Tool (MMAT). We retrieved 4428 papers and screened their titles and abstracts, 36 articles were selected for full-text assessment, resulting in nine articles included in the final analysis. Most interventions described support for parents whose child died during the prenatal or neonatal period. The primary interventions included psychological counseling, creating mementos (such as photographs or footprints), and bereavement workshops. Only one paper described a fully established bereavement program for parents. Eight of the papers met high-quality criteria. Although bereavement care is crucial for parents whose child has died, only a few studies have documented bereavement interventions in LMICs. More research may help with bereavement program implementation and improved care for bereaved parents in LMICs. [ABSTRACT FROM AUTHOR]

Adolescents' health behaviors and experiences contribute to many outcomes, including risks for HIV, other sexually transmitted diseases, and unintended pregnancy. Public health interventions and approaches addressing risk behaviors or experiences in adolescence have the potential for wide-reaching impacts on sexual health and other related outcomes across the lifespan, and schools are a critical venue for such interventions. This paper describes a school-based program model developed by the Centers for Disease Control and Prevention's Division of Adolescent and School Health for preventing HIV/sexually transmitted diseases, unintended pregnancy, and related health risk behaviors and experiences among middle and high school students. This includes a summary of the theoretical and evidence base that inform the model, and a description of the model's activities, organized into three key strategies (sexual health education, sexual health services, and safe and supportive environments) and across three cross-cutting domains (strengthening staff capacity, increasing student access to programs and services, and engaging parent and community partners). The paper also outlines implications for adolescent health professionals and organizations working across schools, clinics, and communities, to address and promote adolescent sexual health and well-being. [ABSTRACT FROM AUTHOR]

To integrate existing literature on barriers and facilitators to implementing interventions for Medically Unexplained Symptoms (MUS) in primary and secondary care. Systematic review following PRISMA guidelines. A search of PsychINFO/Pubmed/Web of Science was performed to select studies focusing on MUS-interventions and implementation. All included papers were checked for quality and bias. A narrative synthesis approach was used to describe the included papers by implementation level, ranging from the specific intervention to the broader economic/political context. 20 (quantitative/qualitative/mixed design) papers were included, but the quantitative studies especially, lacked methodological quality, with possible publication bias as a result. Results showed that the intervention needs to be acceptable and in line with daily practice routines. The professional 's attitude and skills are important for implementation success, as well as for overcoming problems in the professional-patient interaction. If patients stick to finding a somatic cause, this hampers implementation. A lack of time is a frequently mentioned barrier at the organizational level. Barriers/facilitators at the social context level and at the economic/political level were barely reported on in the included papers. Results were integrated into an existing implementation model, as an example of how MUS-interventions can be successfully implemented in practice. [ABSTRACT FROM AUTHOR]

This study evaluated the implementation and outcomes of a multisite initiative to identify and intervene in adolescent substance use across the many settings where youth interact. This paper focuses on the implementation and intermediate outcomes of the initiative, while others in the supplement address impact and ultimate outcomes. A mixed-methods cross-grantee evaluation was conducted from 2014 to 2019 among 56 recipients of funding from the Conrad N. Hilton Foundation to implement screening, brief intervention, and referral to treatment (SBIRT) across more than 1,266 youth-facing settings. Qualitative and quantitative data were collected from grantees on a quarterly basis, as well as from grantee proposals, progress reports, monthly grantee monitoring calls, and survey findings. Grantees reported increased capacity to provide SBIRT to youth across various settings: pediatric and primary care practices, community behavioral health organizations, juvenile justice programs, schools, and community-based organizations. Collectively, grantees screened 141,230 youth for substance use, 12,272 received a brief intervention, and 2,212 were referred to treatment. As part of the initiative, grantees provided SBIRT training to over 37,000 nursing and social work students, medical residents, addiction medicine fellows, and others. Implementation challenges included fitting screening into the workflow of primary care settings, confidentiality and consent in schools, reimbursement, and lack of specialist providers to refer to for substance use disorder treatment. Intermediate outcomes collected include total numbers of youth screened, received a brief intervention, and/or referred to more intensive treatment based on their screening scores. Research on SBIRT in adolescents has been limited to date despite positive outcomes reported in adults. This mixed-methods evaluation of an initiative to expand SBIRT implementation demonstrates feasibility of expanding access to substance use screening and intervention for youth across multiple settings and identifies challenges of implementation that differ somewhat based on settings. [ABSTRACT FROM AUTHOR]

Background: Constrained optimization methods are already widely used in health care to solve problems that represent traditional applications of operations research methods, such as choosing the optimal location for new facilities or making the most efficient use of operating room capacity.Objectives: In this paper we illustrate the potential utility of these methods for finding optimal solutions to problems in health care delivery and policy. To do so, we selected three award-winning papers in health care delivery or policy development, reflecting a range of optimization algorithms. Two of the three papers are reviewed using the ISPOR Constrained Optimization Good Practice Checklist, adapted from the framework presented in the initial Optimization Task Force Report. The first case study illustrates application of linear programming to determine the optimal mix of screening and vaccination strategies for the prevention of cervical cancer. The second case illustrates application of the Markov Decision Process to find the optimal strategy for treating type 2 diabetes patients for hypercholesterolemia using statins. The third paper (described in Appendix 1) is used as an educational tool. The goal is to describe the characteristics of a radiation therapy optimization problem and then invite the reader to formulate the mathematical model for solving it. This example is particularly interesting because it lends itself to a range of possible models, including linear, nonlinear, and mixed-integer programming formulations. From the case studies presented, we hope the reader will develop an appreciation for the wide range of problem types that can be addressed with constrained optimization methods, as well as the variety of methods available.Conclusions: Constrained optimization methods are informative in providing insights to decision makers about optimal target solutions and the magnitude of the loss of benefit or increased costs associated with the ultimate clinical decision or policy choice. Failing to identify a mathematically superior or optimal solution represents a missed opportunity to improve economic efficiency in the delivery of care and clinical outcomes for patients. The ISPOR Optimization Methods Emerging Good Practices Task Force's first report provided an introduction to constrained optimization methods to solve important clinical and health policy problems. This report also outlined the relationship of constrained optimization methods relative to traditional health economic modeling, graphically illustrated a simple formulation, and identified some of the major variants of constrained optimization models, such as linear programming, dynamic programming, integer programming, and stochastic programming. The second report illustrates the application of constrained optimization methods in health care decision making using three case studies. The studies focus on determining optimal screening and vaccination strategies for cervical cancer, optimal statin start times for diabetes, and an educational case to invite the reader to formulate radiation therapy optimization problems. These illustrate a wide range of problem types that can be addressed with constrained optimization methods. [ABSTRACT FROM AUTHOR]

Objectives: Public health safety and environmental management are concerns that pose challenges worldwide. This paper briefly assesses a selected impact of the environment on public health. Study design: The study used an assessment of environmental mechanism to analyse the underlying different pathways in which the health sector is affected in inadequate hospital and health care settings. Methods: We reviewed the limited available evidence of the association between the health sector and the environment, and the likely pathways through which the environment influences health. The paper also models the use of private health care as a function of costs and benefits relative to public care and no care. Results: The need to enhancing policies to improve the administration of health services, strengthening interventions on environment using international agreements, like Rio Conventions, including measures to control hospital-related infection, planning for human resources and infrastructure construction development have linkage to improve environment care and public health. The present study findings partly also demonstrate the influence of demand for health on the environment. Conclusion: The list of possible interventions includes enhancing policies to improve the administration of health services, strengthening Rio Conventions implementation on environmental concerns, control of environmental hazards and public health. [ABSTRACT FROM AUTHOR]

Introduction: Community pharmacists are pivotal in the provision of Maternal and Child Health (MCH) services, yet level of involvement, practice and barriers and facilitators in providing these services is largely unknown.Objective: The objective of this review is to summarize available evidence on the involvement and practice of community pharmacists in MCH services.Methods: Seven electronic databases (PubMed, CINAHL, ProQuest Health, Cochrane library, Scopus, Embase, and Web of Science) were searched for articles published in English since inception of the database to November 30, 2019. Papers were included if they assessed involvement and practices of community pharmacists in maternal and child health services. Full articles identified and included for the final analysis were assessed for quality using the Mixed Method Appraisal Tool (MMAT) (2018) by all authors and data were extracted by one author and cross-checked by all authors.Result: A total of 2830 articles were identified. Following the assessment against the inclusion criteria, 14 full text articles were included for the final analysis. In eight studies, community pharmacists were reported to have involvement in maternal health services, in terms of providing breastfeeding guidance, counselling about the benefit of vitamins during pregnancy, provision of emergency contraception advice, and responding to illness symptoms such as back pain. In three studies, community pharmacists were providing advice in managing acute diarrhea in children. Medication use services and counselling about medication for children were also reported in three studies. Perceived consumer attitudes, problem with insurance coverage, lack of time among pharmacists and lack of incentives for the services provided were reported by pharmacists as the main barriers to service provision.Conclusion: Community pharmacists were involved in various MCH services in community pharmacy settings. However, the extent of practices was not as per the joint International Pharmaceutical Federation (FIP)/World Health Organization (WHO) guidelines on good pharmacy practice in some services such as management of diarrhea. [ABSTRACT FROM AUTHOR]

Background: WhatsApp is an instant messaging application that has grown in popularity over the last decade. The literature has focused on the use of WhatsApp in medical, surgical and nursing disciplines, with little work exploring pharmacists' experiences of using WhatsApp to provide services.Objective(s): The aim of this research was to explore pharmacists' experiences of using WhatsApp to support delivery of out-of-hours pharmacy services.Methods: A qualitative design was underpinned by a phenomenological philosophy. Focus groups and an extract of the WhatsApp transcript were thematically analysed using NVivo.Results: Over three hundred communication events (1580 messages) were analysed in the WhatsApp transcript. Message type was classified as follows; handover (26%, n = 410), procedural queries (26%, n = 410), laptop location (18%, n = 284), whole staff communication (24%, n = 379), clinical queries (5%, n = 79), and administrative communications (1%, n = 16). A total of five focus groups were conducted between October and November 2017 with 27 participants that included pharmacists with different levels of experience. The findings suggest that WhatsApp improved communication between junior and senior pharmacists, particularly during the global cyber crisis, and provided an opportunity to share best practice. Concerns were raised regarding the encroachment of work activities into personal time. Additionally, the tacit approval by senior pharmacists to group information sharing and solution development, despite the potential for non-active participation, highlighted the issue of collective complicity.Conclusions: WhatsApp can be a useful platform to support the delivery of out-of-hours services through professional development, improving communication and supporting relationships. This paper demonstrates that service managers must consider multiple ethico-legal and social frameworks when developing or allowing the organic development of such communication methods within healthcare provider organisations. [ABSTRACT FROM AUTHOR]

Evidence-based therapies for posttraumatic stress disorder are underutilized and at times unavailable in specialty settings. We reviewed the literature on interventions to treat PTSD within primary care to make recommendations on their effectiveness as treatment modalities or ways to improve engagement in specialty care. We searched PubMed, PsychInfo, CINHAL, and Cochrane Reviews databases using search terms related to PTSD and primary care. We excluded clinical guidelines and studies of screening only or subthreshold PTSD. 524 articles were identified. Twenty-one papers on 15 interventions met review criteria. Seven interventions focus on individual therapies studied via small feasibility studies to prepare for full-scale intervention research. Eight describe treatment programs in primary care based on collaborative care that included medication management, tracking outcomes, referral services, and for some psychotherapy (versus psychotherapy referral). Ten interventions were feasibility studies which precludes meaningful comparison of effect sizes. Of the four RCTs of treatment programs, only two including some psychotherapy found improvements in PTSD symptoms. More research is needed to adapt treatment for PTSD to primary care. Collaborative care may be a promising framework for improving the reach of PTSD treatments when psychotherapy is offered within the collaborative care team. [ABSTRACT FROM AUTHOR]

Catheter associated urinary tract infections are one of the most common infections acquired in hospital. A recent randomised control study demonstrated the benefit of using chlorhexidine (0.1%) for meatal cleaning prior to urinary catheter insertion, by reducing both catheter associated asymptomatic bacteriuria and infection. These findings raise the important question of whether a decision to switch from saline to chlorhexidine was likely to be cost-effective. The aim of this paper was to evaluate the cost-effectiveness of adopting routine use of chlorhexidine for meatal cleaning prior to urinary catheter insertion The outcomes of this cost-effectiveness study are changes to health service costs in $AUD and changes to quality adjusted life years from a decision to adopt 0.1% chlorhexidine for meatal cleaning prior to urinary catheter insertion as compared to saline. Effectiveness outcomes for this study were taken from a 32 week stepped wedge randomised controlled study conducted in three Australian hospitals. The changes in health costs from switching from saline to 0.1% chlorhexidine per 100,000 catheterisations would save hospitals AUD$387,909 per 100,000 catherisations, prevent 70 cases of catheter associated urinary tract infections, release 282 bed days and provide a small improvement in health benefits of 1.43 quality adjusted life years. Using a maximum willingness to pay for a marginal quality adjusted life year threshold of AUD$28,000 per 100,000 catherisations, suggests that adopting chlorhexidine would be cost effective and potentially cost-saving. The findings from our work provide evidence to health system administrators and those responsible for drafting catheter associated urinary tract infections prevention guidelines that investing in switching from saline to chlorhexidine is not only clinically effective but also a sensible decision in the context of allocating finite healthcare resources. [ABSTRACT FROM AUTHOR]

Abstract The disproportionate concentration of healthcare professionals in urban areas is a concern in many countries, including Canada. A need to address this rural care gap has driven a large number of government led initiatives worldwide over the years. This paper presents a model that can be used as a tool to examine the efficacy of such policies on the workforce distribution in the long term. A small system dynamics model is employed to simulate the current and future distribution of general physicians at a jurisdictional level. The model represents the transition of general practitioners to provide insight into the dynamics of care provision over time. The movement, and competition, between rural and urban areas is modeled to enable detailed exploration of the ability for proposed measures to alleviate the care gap in the future. Among the tested policies are such commonly used initiatives as financial incentives to rural professionals, promotion of medical education in rural areas, expansion of rural education programs and the engagement of international medical graduates etc. We demonstrate how the model can be used as a tool to determine an efficient and well-chosen combination of policies which can help alleviate the rural care gap in the future, given that some policies are more effective than others alone but also combined with other initiatives. The presented small system dynamics model is tested on Canada's reality, but its simple nature lends itself to easy application to other countries that experience a similar problem. Highlights • A small system dynamics model is used to simulate the current and future distribution of general physicians. • The model provides a tool to explore the efficacy of policies employed to alleviate the rural care gap in the future. • Careful selection and combination of policies offers potential to improve rural areas underserved by general practitioners. [ABSTRACT FROM AUTHOR]

Abstract Objectives The aim of this meta-ethnographic review was to examine refugee women's experiences negotiating motherhood and maternity services in a new country with a view to identifying the specific needs of refugee women accessing maternity care in high income countries. Design A meta-ethnographic synthesis of qualitative research. Data sources Five databases were searched for papers published in English between January 2000 and January 2017. Review methods The synthesis process was guided by the seven steps of meta-ethnography. The quality of included studies was assessed using the COREQ tool. Results One overarching theme and three major themes emerged from the synthesis. The overarching theme "Living between two cultures" conveyed women's experience of feeling "in between" cultures and described refugee women's experience of striving to maintain a strong cultural identity from their country of origin while simultaneously adapting to their new context and country. This theme permeated the following three major themes: 1) "Constructing maternal identity across cultures" which discusses the cultural conflict experienced by refugees accessing maternity services in their host country; 2) "Understanding in practice" which describes reciprocal issues in communication between women and health professionals; and 3) "Negotiating care" which illustrates a mix of coping mechanisms which refugee women utilise to navigate health services in the context of high income countries. Conclusion Liminality is a ubiquitous experience for refugee women seeking maternity care in high income countries. It impacts feelings of belonging and connection to services and society. It is often a challenging experience for many women and a time in which they reformulate their identity as a citizen and a mother. This review found that the experience of liminality could be perpetuated by social factors, and inequality of healthcare provision, where communication and cultural barriers prevented women accessing care that was equal, accessible, and meaningful. Findings revealed both positive and negative experiences with maternity care. Continuity, culturally appropriate care, and healthcare relationships played an important role in the positive experiences of women. The review also revealed the damaging effects of disparities in care experienced by refugee women. [ABSTRACT FROM AUTHOR]

Abstract In this paper a multivariate negative binomial–Lindley distribution is introduced. The univariate version of this distribution comprises an alternative of the model proposed by Zamani and Ismail (2010). With respect to this latter model, this representation presents some advantages since it provides a tractable model with attractive properties that makes it suitable for application in any field where overdispersion is observed. Some properties of the model are studied including a recurrence for the probabilities of the multivariate and univariate distribution. An EM algorithm is derived to estimate the parameters of this multivariate distribution. Finally, some numerical applications for the univariate and bivariate cases are given to illustrate the performance of this model. [ABSTRACT FROM AUTHOR]

Objectives: Little is known about women's use of health services affected by headache or migraine during pregnancy. This paper directly addresses the research gap reporting on the healthcare utilization among Australian pregnant women experiencing headache or migraine.Design and Setting: In this retrospective observational study, data on 1,835 Australian pregnant women were obtained from the nationally-representative Australian Longitudinal Study on Women's Health. Information on quality of life and health seeking behaviors regarding conventional medicine and complementary and alternative medicine providers was identified among these participants. Factors associated with healthcare use were analyzed using regression analyses.Results: A total of 16% of the pregnant women surveyed experienced headache or migraine, and over 20% sought help from more than two types of healthcare practitioners for their headache or migraine. General practitioners (37.8%) were the most commonly consulted providers of pregnant women for their headache or migraine. Women with headache or migraine during pregnancy had worse health-related quality of life than those without. Education level and private health insurance status of pregnant women are the predictors of the use of healthcare practitioners for their management of headache or migraine (both p < 0.05).Conclusions: Headache or migraine during pregnancy significantly impacts upon pregnant women's quality of life. The use of multiple healthcare practitioners, including conventional medicine and complementary and alternative medicine practitioners, highlights the need for further research investigating health services utilization of pregnant women with headache or migraine in different severity and frequency to help inform effective and safe treatment. [ABSTRACT FROM AUTHOR]

Recently, cloud computing gained an important role in healthcare services (HCS) due to its ability to improve the HCS performance. However, the optimal selection of virtual machines (VMs) to process a medical request represents a big challenge. Optimal selection of VMs performs a significant enhancement of the performance through reducing the execution time of medical requests (tasks) coming from stakeholders (patients, doctors, etc.) and maximizing utilization of cloud resources. For that, this paper proposes a new model for HCS based on cloud environment using Parallel Particle Swarm Optimization (PPSO) to optimize the VMs selection. In addition, a new model for chronic kidney disease (CKD) diagnosis and prediction is proposed to measure the performance of our VMs model. The prediction model of CKD is implemented using two consecutive techniques, which are linear regression (LR) and neural network (NN). LR is used to determine critical factors that influence on CKD. NN is used to predict of CKD. The results show that, the proposed model outperforms the state-of-the art models in total execution time the rate of 50%. In addition, the system efficiency regarding real-time data retrieval is greatly improved by 5.2%. In addition, the accuracy of hybrid intelligent model in predicting of CKD is 97.8%. The proposed model is superior to most of the referred models in the related works by 64%. [ABSTRACT FROM AUTHOR]

Background Advanced practice nurses (e.g., nurse practitioners and clinical nurse specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of nurse practitioner and clinical nurse specialist roles, their cost-effectiveness has been challenged. The poor quality of economic evaluations of these roles to date raises the question of whether current economic evaluation guidelines are adequate when examining their cost-effectiveness. Objective To examine whether current guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles. Methods Our methodological review was informed by a qualitative synthesis of four sources of information: 1) narrative review of literature reviews and discussion papers on economic evaluation of advanced practice nursing roles; 2) quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials; 3) review of guidelines for economic evaluation; and, 4) input from an expert panel. Results The narrative literature review revealed several challenges in economic evaluations of advanced practice nursing roles (e.g., complexity of the roles, variability in models and practice settings where the roles are implemented, and impact on outcomes that are difficult to measure). The quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials identified methodological limitations of these studies. When we applied the Guidelines for the Economic Evaluation of Health Technologies: Canada to the identified challenges and limitations, discussed those with experts and qualitatively synthesized all findings, we concluded that standard guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles and should be routinely followed. However, seven out of 15 current guideline sections (describing a decision problem, choosing type of economic evaluation, selecting comparators, determining the study perspective, estimating effectiveness, measuring and valuing health, and assessing resource use and costs) may require additional role-specific considerations to capture costs and effects of these roles. Conclusion Current guidelines for economic evaluation should form the foundation for economic evaluations of nurse practitioner and clinical nurse specialist roles. The proposed role-specific considerations, which clarify application of standard guidelines sections to economic evaluation of nurse practitioner and clinical nurse specialist roles, may strengthen the quality and comprehensiveness of future economic evaluations of these roles. [ABSTRACT FROM AUTHOR]

Background Despite recommendations that women give birth with a skilled birth attendant (SBA), 70% of births in Guatemala occur outside health facilities with informally trained traditional birth attendants (TBAs). To increase SBA in rural, indigenous communities, a professional midwifery school accredited by the government is scheduled to open in 2017. Drawing from Filby's model on barriers to the successful integration of professional midwifery into health systems, this paper aims to identify threats - and facilitators-toward professional midwifery's re-introduction in Guatemala. Methods To elucidate perceptions, attitudes and expectations towards professional midwifery, qualitative, in-depth interviews were conducted with 32 physicians, nurses, and TBAs in six health centers and with key decision makers and professional midwives (PMs) in Guatemala City. We conducted open and axial coding in Atlas.ti and performed normative comparisons of participants’ attitudes, perceptions, and expectations with the National Vision for professional midwifery and relative comparisons within and across disciplinary subgroups. Results Unprompted, physicians, nurses and TBAs were unable to correctly define professional midwifery. Yet, when professional midwifery was defined for them, they expressed willingness to work with PMs, seeing them as a needed human resource, instrumental in providing intercultural care and strengthening facility relationships with TBAs. Some stakeholders anticipated resistance toward PMs due to provider turf issues. Notable differences in expectations among all groups included ideas for supervision of and by the PMs and the PM's role in monitoring women and conducting births in communities alongside TBAs. Conclusions Facilitators to professional midwifery's success include national political will, stakeholders' uniformity of vision, and the potential for improved intercultural care. Barriers are mostly professional in nature, including impediments to autonomous practice by PMs, hierarchical challenges, and turf issues. A specific road map addressing the identified barriers is needed for professional midwifery to succeed in reducing maternal health disparities in Guatemala. [ABSTRACT FROM AUTHOR]

Stable routines are key to successful illness self-management for the growing number of people living with chronic illness around the world. Yet, the influence of chronically ill individuals' everyday contexts in supporting routines is poorly understood. This paper takes a space-time geographical approach to explore the everyday space-time contexts and routines of individuals with chronic kidney disease (CKD). We ask: what is the relationship between renal patients' space-time contexts and their ability to establish and maintain stable routines, and, what role does health service access play in this regard? We draw from a qualitative case study of 26 individuals with CKD in Australia. Data comprised self-reported two day participant diaries and semi-structured interviews. Thematic analysis of interview transcripts was guided by an inductive-deductive approach. We examined the embeddedness of routines within the space-time contexts of participants' everyday lives. We found that participants' everyday space-time contexts were highly complex, especially for those receiving dialysis and/or employed, making routines difficult to establish and vulnerable to disruption. Health service access helped shape participants' everyday space-time contexts, meaning that incidences of unpredictability in accessing health services set-off ‘ripple effects’ within participants' space-time contexts, disrupting routines and making everyday life negotiation more difficult. The ability to absorb ripple effects from unpredictable health services without disrupting routines varied by space-time context. Implications of these findings for the deployment of the concept of routine in health research, the framing of patient success in self-managing illness, and health services design are discussed. In conclusion, efforts to understand and support individuals in establishing and maintaining routines that support health and wellbeing can benefit from approaches that contextualise and de-centre everyday human behaviour. Opportunities to support renal patients in managing illness and experiencing wellbeing outside the clinical setting lie in a space-time re-design of chronic care services. [ABSTRACT FROM AUTHOR]

Despite the recognition that behavioral and medical health conditions are frequently intertwined, the existing health care system divides management for these issues into separate settings. This separation results in increased barriers to receipt of care and contributes to problems of underdetection, inappropriate diagnosis, and lack of treatment engagement. Adolescents and young adults with mental health conditions have some of the lowest rates of treatment for their conditions of all age groups. Integration of behavioral health into primary care settings has the potential to address these barriers and improve outcomes for adolescents and young adults. In this paper, we review the current research literature for behavioral health integration in the adolescent and young adult population and make recommendations for needed research to move the field forward. [ABSTRACT FROM AUTHOR]

Introduction Differences in national health data collection systems preclude accurate assessments of how much breast reconstruction (BR) is performed in Australia. This paper aims to quantitatively document and visually map the national prevalence and distribution of BR, using the best available evidence. Materials and methods Quantitative analysis and spatial mapping of hospital-level data on BR prevalence in all six Australian states and two mainland territories. Data was extracted on 3786 women, under the care of members of Breast Surgeons of Australia and New Zealand Incorporated, who had mastectomy for breast malignancy with or without post-mastectomy BR in 2013. Results Analysis revealed a national BR rate of 18.3%. Statistically significant differences in BR uptake (p < .0001) were found between jurisdictions [χ 2 (df = 7) = 284.29], with BR more likely in younger women [χ 2 (df = 14) = 395.62] and in private hospitals (χ 2 = 63.99) and less likely in remote areas [χ 2 (df = 4) = 66.49]. Conclusion Analysis of this substantial subset of Australian women requiring mastectomy for breast cancer has demonstrated significant variation in provision or uptake of BR across four important variables. As BR has been shown to provide long-term survivorship benefits for the growing number of women living longer following mastectomy for breast cancer, there is an urgent need to ensure BR is accessible and affordable for all women who choose this option. [ABSTRACT FROM AUTHOR]

This paper examines the factors affecting the Muslim medical tourists' satisfaction, and the role of their attitudes in shaping their clinical experience based on the expectation-disconfirmation paradigm. Data from a survey of 243 Muslim medical tourists who had received treatment from Malaysian Islamic friendly hospitals were analysed using the partial least squares technique. The findings provide evidence that Muslim medical tourists' satisfaction is dependent on the doctors' and hospitals' roles; whilst, the nurse's halal practice is not associated with it. The study also demonstrates that Muslim medical tourists' attitudes only play a mediator role between the hospital's halal practice and Muslim medical tourists' satisfaction. The research result provides useful information in understanding the critical halal practices and, more particularly, aims at helping Islamic hospitals offer quality healthcare services that suit the Muslim medical tourists' needs and, consequently, attracts the Islamic medical tourists. [ABSTRACT FROM AUTHOR]

Disgust is a common emotion experienced by healthcare professionals which in extreme cases can contribute to neglect and abuse of patients. However, little research has explored how healthcare professionals experience disgust and what coping strategies they use to manage it. To identify, evaluate and synthesise results from empirical papers that have explored how healthcare professionals experience, understand and manage disgust in clinical work. A narrative literature review. Using the EBSCOHost interface, a range of databases were systematically searched alongside manual searches and citation chaining which yielded the 11 papers included in this review. Qualitative synthesis. Three major themes were identified: The professionals' struggle to talk about disgust; the importance of boundaries: boundary breaching and boundary building; and the role of empathy in caring. This review found that disgust is a common experience for healthcare professionals, yet it is not talked about or openly expressed. Professionals have developed ways to cope with disgust and use empathy as a main strategy to overcome it. The review suggests that healthcare professionals should consider ways of making disgust part of a wider conversation, allowing clinicians to engage with their feelings, rather than feel ashamed of them and hiding disgust away as a silent part of care. [ABSTRACT FROM AUTHOR]

There is little doubt about the effects of drought events on human health in the present climate. Projections of climate change indicate an increase in the occurrence and severity of droughts in the 21st century in a number of regions, thus it is likely that these types of hydrological extremes could have more of an impact if appropriate adaptation measures are not taken. The majority of studies on the effects of drought are focused on meteorological, agricultural, or hydrological contexts, but there are rather fewer assessments of the impacts of droughts on health. In particular, there have been hardly any attempts to compare different drought indices in order to identify and quantify the impacts of drought on health systems. In addition, rather better knowledge is needed on the mechanisms of vulnerability involved. In this paper, we attempt to describe the complexity of drought phenomena and the difficulty involved in quantifying the health risks linked to their occurrence. From an international perspective, we provide a brief review of the harmful effects of droughts on health in the context of climate change, as well as the vulnerability factors related to droughts. We make an assessment of aspects that have not yet been investigated, or which require further attention to be devoted to this topic. The principal aim of this paper is therefore to draw attention to the need to consider closely the relationship between drought indices and human health, in order to achieve a more fundamental understanding, and to propose specific courses or lines of action for future years, which could eventually be of use to healthcare providers and services. [ABSTRACT FROM AUTHOR]

Introduction: There are increasing numbers of mHealth initiatives in middle and low income countries aimed at improving health outcomes. Bangladesh is no exception with more than 20 mobile health (mHealth) initiatives in place. A recent study in Bangladesh examined community readiness for mHealth using a framework based on quantitative data. Given the importance of a framework and the complementary role of qualitative exploration, this paper presents data from a qualitative study which complements findings from the quantitative study.Methods: The study was conducted in the Chakaria sub-district of Bangladesh. In total, 37 in-depth interviews were conducted between December 2012 and March 2013. Participants included the general public, students, community leaders, school teachers, and formal and informal healthcare providers. Thematic analysis was used to develop a logical and relevant framework to examine community readiness. As in the quantitative exploration, this study approached the investigation with four types of readiness in mind: core readiness, technological readiness, human resource readiness and motivational readiness.Results: Community members, community leaders and healthcare providers expressed their interest in the use of mHealth in rural Bangladesh. Awareness of mHealth and its advantages was low among uneducated people. Participants who have used mHealth were attracted to the speed of access to qualified healthcare providers, time savings and low cost. Some participants did not see the value of using mobile phones for healthcare compared to a face-to-face consultation. Illiteracy, lack of English language proficiency, lack of trust and technological incapability were identified as barriers to mHealth use. However, a sense of ownership, evidence of utility, a positive attitude to the use of mHealth, and intentions towards future use of mHealth were driving forces in the adoption of mHealth services.Conclusions: This study re-affirmed the mHealth readiness conceptual framework with different dimensions of readiness and identified potential barriers and possible solutions for mHealth. Moving forward, emphasis should be placed on training users, providing low-cost services and improving trust of users. [ABSTRACT FROM AUTHOR]

One of the main focuses of disaster management is to decrease the impact of disasters by developing efficient emergency management plans and strategies. In this context, accessibility modeling of emergency related services such as health, fire, security services, or shelter sites in earthquake case can be a valuable tool for disaster managers, especially in assessing the vulnerability of urban districts as well as the sufficiency and appropriateness of the emergency service sites. Although there are several studies on the accessibility modeling of emergency related services in the aftermath of a disastrous event, the literature that integrates road closure probabilities into the accessibility estimation is quite limited. Hence, this paper aims to develop a methodology for modeling of accessibility based on a probabilistic estimation of road closures in earthquake case. The mentioned probabilities are predicted for given road network and hazard acting upon it and then incorporated into the accessibility analysis. The developed methodology is demonstrated through an application on health services and shelter sites in the city of Thessaloniki in Greece with and without considering the road closures, corresponding to road network under earthquake and normal conditions respectively. In this particular study, the road closures are associated to ground failure and damage to bridges, as well as damage of overpasses and collapses of buildings adjacent to road edges. The developed methodology could provide advanced and more realistic support to the emergency managers and decision-makers who deal with accessibility, location/allocation, and service/catchment area of critical facilities. [ABSTRACT FROM AUTHOR]

Background/purpose: Taiwan has one of the fastest growing aging populations in the world, which makes the effective allocation of scarce medical resources a key issue. This paper investigates patterns in the use of outpatient services by elderly individuals in Taiwan under the National Health Insurance (NHI) program.Methods: We assembled a random sample from the NHI Research Database in Taiwan, comprising 50% of all claims made for elderly people (65 years old) in 2010 (n 1,239,836 beneficiaries) including 14 variables.Results: In 2010, individuals aged 65 years or older comprised 10.74% of the population of Taiwan, and accounted for 11.39% of all physician and outpatient visits. The rate of medical care visits was 28.54 ± 21.23 (Standard deviation) times per person per annum, with a higher rate for women, those in the 80-84 age group, low-income beneficiaries, and the inhabitants of offshore islands. The three most frequent diagnoses for elderly patients were hypertension, diabetes, and acute upper respiratory infections. The mean insured medical costs per person per annum were US Dollars 1,132, with higher expenses for men, those in the 80-84 age group, and those inhabiting urban areas.Conclusion: This study employed nationally representative data in the detection of patterns in outpatient care utilization by elderly individuals in Taiwan. Medical care providers and policymakers should be fully aware of the complex patterns unique to older patients. The results of this study could be used as a benchmark with which to assess the impact of future medical care policy on elderly people. [ABSTRACT FROM AUTHOR]

Patient delivery time is no longer considered as the only critical factor, in ambulatory services. Presently, five clinical performance indicators are used to decide patient satisfaction. Unfortunately, the emergency ambulance services in rapidly growing metropolitan areas do not meet current satisfaction expectations; because of human errors in the management of the objects onboard the ambulances. But, human involvement in the information management of emergency interventions can be reduced by electronic tracking of personnel, assets, consumables and drugs (PACD) carried in the ambulances. Electronic tracking needs the support of automation software, which should be integrated to the overall hospital information system. Our work presents a complete solution based on a centralized database supported by radio frequency identification (RFID) and bluetooth low energy (BLE) identification and tracking technologies. Each object in an ambulance is identified and tracked by the best suited technology. The automated identification and tracking reduces manual paper documentation and frees the personnel to better focus on medical activities. The presence and amounts of the PACD are automatically monitored, warning about their depletion, non-presence or maintenance dates. The computerized two way hospital–ambulance communication link provides information sharing and instantaneous feedback for better and faster diagnosis decisions. A fully implemented system is presented, with detailed hardware and software descriptions. The benefits and the clinical outcomes of the proposed system are discussed, which lead to improved personnel efficiency and more effective interventions. [ABSTRACT FROM AUTHOR]

This paper uses a difference-in-difference strategy to evaluate a program in Guatemala that expanded access to health services through two contracting modalities. In the contracting-out model NGOs were responsible for all administrative and clinical procedures, while in the contracting-in model NGOs focused on administrative tasks and employed public employees to provide services. The evaluation design allows comparing results across both contracting models as well as with an area that did not receive additional services. Both models achieved modest results regarding immunization coverage and prenatal care, though contracting in performed slightly better. We also compare program phases and discuss policy implications. [ABSTRACT FROM AUTHOR]

There is growing evidence that providing increased voice to vulnerable or disenfranchised populations is important to improving health equity. In this paper we will examine the engagement of Aboriginal community members and community controlled organisations in local governance reforms associated with the Aboriginal Health National Partnership Agreements (AHNPA) in Australia and its impact on the uptake of health assessments. The sample included qualitative and quantitative responses from 188 people involved in regional governance in Aboriginal health. The study included data on the uptake of Aboriginal health assessments from July 2008 to December 2012. The study population was 83190 in 2008/9, 856986 in 2009/10, 88256 in 2010/11 and 90903 in 2011/12. Logistic regression was used to examine the relationships between organisations within forums and the regional uptake of Aboriginal health assessments. The independent variables included before and after the AHNPA, state, remoteness, level of representation from Aboriginal organisations and links between Aboriginal and mainstream organisations. The introduction of the AHNPA was associated with a shift in power from central government to regional forums. This shift has enabled Aboriginal people a much greater voice in governance. The results of the analyses show that improvements in the uptake of health assessments were associated with stronger links between Aboriginal organisations and between mainstream organisations working with Aboriginal organisations. Higher levels of community representation were also associated with improved uptake of health assessments in the AHNPA. The findings suggest that the incorporation of Aboriginal community and community controlled organisations in regional planning plays an important role in improving health equity. This study makes an important contribution to understanding the processes through which the incorporation of disadvantaged groups into governance might contribute to health equity. [ABSTRACT FROM AUTHOR]

This paper presents results of a research priority setting process focused on trans women living with and affected by HIV across Canada. It features data from semi-structured interviews and focus groups conducted with a diverse group of 76 trans women in five urban centers across the country on how they have navigated health and social service programming within their geographic context. The results focus on the structure and types of services. Respondents offered simple, yet creative ways to address barriers to vital services based on their individual and collective experiences. Notably, participants stressed the need for 1) trans-friendly and trans-specific services, 2) integrated health services, and aid in navigating complex, overlapping systems, and 3) comprehensive community-based services. They also suggest employing trans women as care coordinators or case managers in order to foster more trans-friendly environments and empower community members. We identify concrete ways to improve health and social services at the level of service delivery and program design, as well as recommendations for future participatory research. We close with an interrogation of trans people, and trans women living with and affected by HIV in particular, as 'hard to reach' populations. • Research with trans women yields richer insights if trans-identified experts lead. • Trans-friendly and trans-specific modes of service design and provision differ. • Integrated services are vital, but must address nuance of transgender women's needs. • Trans women are not hard to reach; rather, it is services that are hard to access. • Our trans-led community-based participatory approach can and should be reproduced. [ABSTRACT FROM AUTHOR]

Problem Midwifery practice is emotional and, at times, traumatic work. Cumulative exposure to this, in an unsupportive environment can result in the development of psychological and behavioural symptoms of distress. Background As there is a clear link between the wellbeing of staff and the quality of patient care, the issue of midwife wellbeing is gathering significant attention. Despite this, it can be rare to find a midwife who will publically admit to how much they are struggling. They soldier on, often in silence. Aim This paper aims to present a narrative review of the literature in relation to work-related psychological distress in midwifery populations. Opportunities for change are presented with the intention of generating further conversations within the academic and healthcare communities. Methods A narrative literature review was conducted. Findings Internationally, midwives experience various types of work-related psychological distress. These include both organisational and occupational sources of stress. Discussion Dysfunctional working cultures and inadequate support are not conducive to safe patient care or the sustained progressive development of the midwifery profession. New research, revised international strategies and new evidence based interventions of support are required to support midwives in psychological distress. This will in turn maximise patient, public and staff safety. Conclusions Ethically, midwives are entitled to a psychologically safe professional journey. This paper offers the principal conclusion that when maternity services invest in the mental health and wellbeing of midwives, they may reap the rewards of improved patient care, improved staff experience and safer maternity services. [ABSTRACT FROM AUTHOR]

Background The first responder, faced with any obstetric incident, frequently finds themselves within a dichotomy of multi-tasking activities. One challenge for the midwife, is to keep accurate and contemporaneous medical records, whilst simultaneously providing immediate clinical care. Aim This paper aims to propose an innovative conceptualisation and a practical solution for maternity services, which strive to uphold best practice in creating contemporaneous and accurate medical records. The feasibility of introducing the use of voice recorders within maternity services will be explored, and offered as a mechanism to facilitate record keeping and simultaneous clinical care. Methods A synthesised narrative review of the literature is conducted. This review academically tests the conceptual hypothesis that the implementation of voice recorders within maternity services may augment the midwife's ability to generate contemporaneous medical records. A background literature review will also explore the key drivers for this particular innovation, and the challenges facing healthcare leaders in service improvement. Findings This paper builds upon previous suggestions that digital voice recorders may be an effective solution to enhance overall obstetric outcomes, and focuses upon conceptual processes for implementation. Conclusions This paper offers the principal conclusion that the integration of voice recorders into midwifery practice for the purpose of supporting contemporaneous record keeping may be feasible within the current healthcare climate. [ABSTRACT FROM AUTHOR]

In the last two decades, India's central and many state governments launched several public health programs with the goal of improving maternal and child health outcomes. Many individual studies assessed the impact of these programs; however, they focused on select health programs and few specific outcomes. This paper summarizes the literature, published during 2000–2019, investigating the impacts of public health programs on both the uptake of maternal and child health services and the related-health outcomes in India. We followed PRISMA guidelines of systematic review, and carried out a narrative synthesis of the study findings. We found 66 relevant studies covering 11 health programs across India. Most studies had applied non-experimental study designs (n = 50), with few applying experimental (n = 1) and quasi-experimental (n = 15) designs. Most studies (n = 64) assessed the impact on the intermediate outcomes of the uptake of various health services rather on the long-term outcomes of improvement in health. Overall we found studies reporting positive impacts, however, we could not find any strong consensus emerging from these studies about the impact, partly due to differences in: outcome indicators; study designs; study population; data sets. Several studies also reported considerable beneficial impacts among low socioeconomic population groups. However, given that the outreach of the public health programs have been low across the country and population groups, we found that broader objectives of health programs remained unassessed: most studies assessed the impact on who actually participated in the program (average treatment effect on-the-treated) rather on the target population (intent-to-treat effect). Furthermore, there was dearth of research on the impacts of the state-level programs. Future research need to assess the impact of the programs on health outcomes, and on quality adjusted measures of maternal and child health services and its continuum of care. • Most studies have focused on the impact on maternal and child health services. • Most studies reported beneficial impact on health services and the health-related outcomes. • Impact on the intended larger target population remains unassessed. [ABSTRACT FROM AUTHOR]

This paper considers an under-examined space in primary health care - the reception area/waiting room. This space can be challenging to negotiate, particularly for those who experience social marginalisation. We begin by situating the significance of the 'entry into the health care setting' in the patient journey in terms of time as well as space. Through an analysis of interview and focus group data gathered in a New Zealand study, we highlight ways that patients view these spaces as firmly bounded and confronting. In reflecting on the data, we then identify the potential for these spaces to be more permeable. We conclude that this spatio-temporal context need not be one of constraint. Rather, there are ways in which the boundaries of this space can be potentially enabling to those required to pause in the process of enacting patienthood. [ABSTRACT FROM AUTHOR]

In the UK, there are over 40,000 childhood cancer survivors (CCS); this figure grows approximately 1300 annually. Two-thirds are at risk of developing serious disabling or life-threatening conditions due to adverse late effects of the cancer or treatment received in childhood. Life-long, follow-up care for the surveillance and management of late effects is recommended. This study explored CCS' views and experiences of long-term follow-up (LTFU) care within a cancer centre. Paper questionnaires (n = 113) and qualitative interviews (n = 13). The majority (n = 83, 80%) of CCS reported being satisfied with their LTFU care and felt that it was important to attend long-term survivorship follow-up (n = 97, 86%). However, some were not well informed about their cancer treatment history, purpose for attending the clinic or the potential for late effects. Barriers associated with LTFU included; provision of information, lack of interpersonal relationships, practical and logistic challenges. Barriers identified can be addressed through strategies including provision of verbal and written information and care plans to increase CCS' knowledge of their cancer history, risk of late effects and the purpose of LTFU care, both at transition and throughout their survivorship journey; patient-centred services that enhance patient choice and flexibility of access to multiple specialities; and use of risk stratified pathways to encourage supported self-management based on cancer type, co-morbidity, and level of professional involvement required. Improving regular provision of information at critical time-points, and exploring a flexible, patient-centred delivery of LFTU care based on risk, could increase attendance and self-management in CCS. What is known? • Two-thirds of childhood cancer survivors (CCS) are at risk of developing serious disabling or life-threatening conditions due to adverse late effects of the cancer or treatment received. •Long-term, follow-up care (LTFU) for surveillance and management of late effects is recommended but internationally take up is low. What does this study add? •Engagement in LTFU was affected by CCS′ not being well informed about their treatment history, purpose for attending the clinic or potential for late effects, lack of interpersonal relationships, practical and logistic challenges. •Engagement can be improved with improved provision of information; flexible services with access to multiple specialities; risk stratified pathways to encourage self-management based on cancer type, co-morbidity, and level of professional involvement required. [ABSTRACT FROM AUTHOR]

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes Love146, an international human rights organization based in the United States and dedicated to ending child sex trafficking and exploitation. Love146′s work began in Southeast Asia and later expanded to the United Kingdom, Liberia and Madagascar. In the United States, Love146′s Survivor Care Program serves as Connecticut's primary provider of specialized services for survivors of DMST. The purpose of the current paper is to detail the successes, challenges, and lessons learned by Love146 in facilitating U.S. survivor access to services that can improve medical and mental health outcomes. [ABSTRACT FROM AUTHOR]