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Over the last few decades, medical and surgical advances have led to a growing population of individuals living with congenital heart disease. The challenges of this condition can reach beyond physical limitations to include anxiety, depression and post-traumatic stress disorder. To date, these psychological outcomes have been neglected; yet, they need not be inevitable. The factors contributing to these difficulties are considered here, drawing on current evidence and neuropsychological theories including the novel application of polyvagal theory. Suggestions for developing psychologically informed medical and social care to improve mental health, wellbeing and recovery and influence policy and training are proposed (See supplemental material for video abstract). [ABSTRACT FROM AUTHOR]

Based upon research in the state of Bihar, India, this article argues that informal access to medicines in Northern India is a core element of the government of healthcare. Informal providers such as unlicensed village doctors and unlicensed drug sellers play a major role in access to medicines in Bihar, in the particular context of the dismantling of public procurement services. Building on recent works in the socio-anthropology of pharmaceuticals, the article shows the importance of taking into account the political economy of drugs in India, in order to understand local problems of access more fully. If informal providers occupy such an important position in the government of healthcare in India, this is partly due to the shaping of healthcare as access to drugs on health markets. Elaborating the argument from interviews with health professionals and patients, the article first shows the situation of public healthcare and public procurement in Bihar; then it presents the role of informal medicine providers; lastly, it shows how patients deal with the fact that they live in a ‘pharmaceutical world’ where access to health equates with access to medicines. [ABSTRACT FROM AUTHOR]

Sexual and gender-based violence (SGBV) is a leading cause of physical, emotional, and psychosocial problems around the world, with many countries in East Africa having rates above the global average. Despite the high prevalence in the region, service provision for post-SGBV care is often poorly funded, difficult to access, or simply nonexistent. This review reports the findings of a scoping review of literature from East Africa. The goals of this research were to evaluate existing service provision practices throughout the region, understand how provider bias may affect service provision, and compare existing practices to national policies and internationally agreed human rights treaties. This review identified 54 academic papers and reports through a search of electronic databases and grey literature sources, and four main themes emerged: (1) current models of service provision are inadequate to address the medical and psychosocial needs of survivors; (2) countries are not providing sufficient funding for services; (3) further research is needed into how to incorporate SGBV care into existing health systems and align with international human rights treaties; and (4) there is limited research in many countries in East Africa. The findings are likely to be of use to policy makers, nongovernmental organizations, and service providers working in the medical, legal, and justice systems. [ABSTRACT FROM AUTHOR]

The majority of U.S. states have legalized marijuana for medical use and some states have legalized marijuana for recreational use; yet, marijuana remains illegal federally. Given the misalignment between state and federal policies, this paper seeks to explore how hospitals handle inpatients' medical marijuana use in states where medical marijuana is legal. To examine this phenomenon, we conducted an anonymous, online, cross-sectional survey of nurse leaders working in acute care inpatient settings in states that had legalized medical marijuana. Using descriptive statistics, we report on these nurse leaders' experiences. There were 811 survey responses—291 who worked in an acute care inpatient setting in a state that had legalized medical marijuana. Among those respondents, only a small percentage reported that inpatients had some access to their medical marijuana: 5.8% reported that the drug was kept in the pharmacy and dispensed like other prescriptions; another 3.4% indicated that patients kept the medical marijuana in their rooms and took it, as needed. Most respondents (55.6%) reported that patients were switched to an alternative medication during their inpatient hospital stays. Almost half (49.4%) of the nurse leaders who reported that alternative medications were used, reported that opioids were substituted, and the majority reported that the marijuana was safer than the opioids. These findings are concerning given the increase in opioid overdose deaths. [ABSTRACT FROM AUTHOR]

The coronavirus pandemic has impacted health care, economies and societies in ways that are still being measured across the world. To control the spread of the virus, governments continue to appeal to citizens to alter their behaviours and act in the interests of the collective public good so as to protect the vulnerable. Demonstrations of collective solidarity are being consistently sought to control the spread of the virus. Catchphrases, soundbites and hashtags such as 'we're all in this together', 'stronger together' and other messages of unity are employed, invoking the sense of a collective struggle. However, this approach is fundamentally challenged as collectivist attitudes run contrary to the individualism of neoliberal ideology, to which citizens have been subjected. This paper argues that attempting to employ the concept of solidarity is inherently challenged by the deep impact of neoliberalism in health policies and draws on the work of Durkheim to examine the concept in a context in which health care has become established as an individual responsibility. The paper will argue that a dominant private-responsibility model and an underfunded public system have eroded solidarity weakening its effectiveness in generating concerns for the collective. [ABSTRACT FROM AUTHOR]

Mitigating the impacts of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and substance use requires comprehensive and systematic thinking in designing interventions and developing policies. This study describes the growth of research publications from 1991 to 2021 in the Web of Science database and points out current research landscapes in the fields of HIV/AIDS and substance use. Latent Dirichlet Allocation was used for classifying 21 359 papers into corresponding topics. The most common topics were HIV transmission, HIV infection, quality of life and mental health of substance users, and the biomedical effect of substance use. Emerging research landscapes include vulnerabilities of people who inject drugs to HIV transmission and related health problems. This study found a lack of research on health services, interdisciplinary and inter-sectoral in combination with clinical evaluation and treatment services. Future investment and implementation of HIV/AIDS and substance use programs should focus on research of health services and clinical evaluation, especially context-specific interventions. [ABSTRACT FROM AUTHOR]

Nursing knowledge is housed in its paradigms, philosophies, models, and theories. This knowledge must be utilized to demark nursing's unique contributions within healthcare, regardless of the setting. The purpose of this paper is to explore the ways in which Parse's community model may serve as a way to think about health policies and the unique ways policies may connect to nursing knowledge. Within this paper, there is a discussion about health policy, Parse's humanbecoming paradigm, and policy development reflected upon with change concepts within the humanbecoming community model. This exploration is important because "disciplinary knowledge is the foundation for transforming health policy and health care delivery systems" (American Academy of Nursing, 2020, para. 1). [ABSTRACT FROM AUTHOR]

Introduction: To support the expansion of a successful regional electronic consultation (eConsult) service, we hosted a full-day national eConsult Policy Think Tank, connecting health-services researchers, clinicians, patients and policymakers to discuss policy considerations related to eConsult. In this paper, we assess the discussion arising from the Think Tank to identify and understand the policy enablers and barriers to the national spread and scale of eConsult services across Canada.Methods: We conducted a constant comparative thematic analysis of stakeholder discussions captured during the Think Tank held in Ottawa, Canada, on 5 December 2016. Forty-seven participants attended and debated the following topic areas: (a) delivery of services and standards; (b) payment considerations; and (c) equitable access. The meeting was recorded, and verbatim transcripts were analysed using qualitative approaches.Results: We identified four themes affecting spread and scale of eConsult innovation from a policy perspective: (a) patient-centredness; (b) value; (c) regulation; and (d) considerations for spread and scale. Patient-centredness was viewed as a foundational principle upon which policy shifts should be guided. Active participation of patient partners transitioned the discussions and resulting recommendations from provider-centred to patient-centred thinking around the relevant policy issues, explicitly demonstrating the importance of patient involvement in healthcare policy decision making.Discussion: eConsult was viewed as a high-value, disruptive innovation with great potential to transform access to specialists in Canada. A patient-centred approach to policy change (and not just healthcare delivery) was identified as a novel yet critical enabler to the scale and spread of eConsult across Canada. [ABSTRACT FROM AUTHOR]

The utilization of nursing theories should serve as the foundation of policies that guide care for patients and those they love. The author of this paper explores linking conceptual elements within nursing theories to high-quality patient-centered care examples and policies. These linkages make clear how nursing knowledge may be utilized within healthcare systems that value patient-centered care. These patient-centered care policies need to be explicit about the contributions of nurses to healthcare, regardless of setting. [ABSTRACT FROM AUTHOR]

A trauma-informed, thematic analysis that identified stress-related themes evident in 39 personal abortion narratives from the Tennessee Stories Project in the United States is presented in this paper. Using the Braun and Clarke model of thematic analysis, guided by the trauma-informed social work framework, researchers examined these narratives to identify stress related themes. Findings: An overall theme of stress and traumatic stress was found to be present throughout the abortion narratives. These themes were categorized into subthemes, including: (a) existing life stressors preceding the abortion experience, (b) stressors while trying to access abortion services, (c) stressors while obtaining abortion services, and (d) stressors arising after the procedure. Applications: These results suggest that stress and traumatic stress were reflected in these abortion narratives throughout the abortion seeking experience. This finding supports the need for social work practice responses that are designed to address and eliminate stress during the process of seeking and obtaining an abortion in the United States. A trauma-informed framework is recommended for guiding social work education about abortion, social worker interactions with clients who are seeking abortions, and the development of abortion policy in the United States in order to better align the abortion seeking experience with the principles of trauma-informed care. [ABSTRACT FROM AUTHOR]

It is important to develop and implement policies that are unique to nursing practice situations. To do so, nurses must participate in policy development that connects disciplinary knowledge with policy formulation. The purpose of this paper is to explore connections between nursing knowledge and transitional care. This is done with a discussion of transitional care definitions and models, along with connections to concepts and principles within extant nursing theories and models. [ABSTRACT FROM AUTHOR]

Relationship management can be applied in a variety of fields, but there is perhaps no other field that could benefit more from the application of relationship management than public health. The achievements of public health in the United States over the last century are many, but its challenges are daunting. This paper begins with a review of the mission of public health and the status of public health in this nation, including an examination of the most significant public health challenges. I then describe the complex nature of the public health system and summarize the latest positive development in public health planning. Finally, I outline how relationship management can be implemented in order to help improve public health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Epidemiologic studies have confirmed that major depression (MD) is an extremely common condition, but also one that is associated with an unexpectedly broad spectrum of morbidity. It is no longer a tenable position to regard MD as being a simple indicator of treatment need, nor is a one-size-fits-all approach to treatment likely to be an effective guide to health care delivery. The objective of this commentary is to explore the implications of these new epidemiologic findings for policy and practice in Canada.Method: This paper is a selective review and commentary.Results: Whereas the acute and long-term treatment needs of a subset of individuals with MD have received much attention in the literature, the needs of other groups have not. A sizable proportion of individuals with episodes meeting the Diagnostic and Statistical Manual of Mental Disorders-fourth edition definition in community populations may not need the intensive treatment emphasized by current Canadian practice guidelines. The strategy of watchful waiting may have a role in primary care. On the policy front, guided and perhaps self-guided management strategies deserve greater emphasis than they have received. Stepped-care strategies are an appealing option, but how best to effectively implement these in the Canadian context is unclear.Conclusions: The spectrum of morbidity among individuals with MD in community populations is much wider than has been previously appreciated. The health system should respond with an appropriate spectrum of services, but many questions remain about how to facilitate this. [ABSTRACT FROM AUTHOR]

It is time to move beyond education about qualitative research theory and methods to using them to understand and improve psychiatric practice. There is a good fit between this agenda and current thinking about research use that broadens definitions of evidence beyond the results of experiments. This paper describes a qualitative program evaluation to illustrate what kind of useful knowledge is generated and how it can be created through a clinician-researcher partnership. The linkage and exchange model of effective knowledge translation described involves interaction between clinicians and researchers throughout the research process and results in mutual learning through the planning, disseminating, and application of existing or new qualitative research in decision making. [ABSTRACT FROM AUTHOR]

In 2003, a large German public health insurance fund launched the GesundheitsCard Europa (GCE) or Health Card Europe. Staff in the 14 participating hospitals along the Dutch and Belgium coast could use a multilingual Website to confirm immediately the insurance status of patients presenting a GCE. Reimbursement was speeded up by using the Web portal in co-operation with the insurance partners. A thorough analysis of the economic performance of the GCE service, accounting for all stakeholders was conducted. The number of paper forms issued by the insurer for travel to The Netherlands fell from about 200,000 annually to about 40,000 per year. In 2004, three years after the project started, cumulative benefits exceeded cumulative costs. The investment was about €500,000 and the annual running costs were about €150,000. In comparison, the overall annual net benefits were about €450,000. The GCE is a proprietary, but generalisable solution to a specific European problem: low acceptance of health insurance certificates. [ABSTRACT FROM AUTHOR]

Objective: Publicly funded cognitive-behavioural therapy (CBT) for mental disorders is scarce in Canada, despite proven efficacy and guidelines recommending its use. This paper reviews published data on the economic impact of CBT to inform recommendations for current Canadian mental health care funding policy.Method: We searched the literature for economic analyses of CBT in the treatment of mental disorders.Results: We identified 22 health economic studies involving CBT for mood, anxiety, psychotic, and somatoform disorders. Across health care settings and patient populations, CBT alone or in combination with pharmacotherapy represented acceptable value for health dollars spent, with CBT costs offset by reduced health care use.Conclusions: International evidence suggests CBT is cost-effective. Greater access to CBT would likely improve outcomes and result in cost savings. Future research is warranted to evaluate the economic impact of CBT in Canada. [ABSTRACT FROM AUTHOR]

The United States is the only western industrialized nation that fails to provide universal coverage and the only nation where health care for the majority of the population is financed by for-profit, minimally regulated private insurance companies. These arrangements leave one-sixth of the population uninsured at any given time, and they leave others at risk of losing insurance as a result of normal lVe course events. Political theorists of the welfare state usually attribute the failure of national health insurance in the United States to broader forces of American political development, but they ignore the distinctive character of the health care financing arrangements that do exist Medical sociologists emphasize the way that physicians parlayed their professional expertise into legal, institutional, and economic power but not the way this power was asserted in the political arena. This paper proposes a theory of stakeholder mobilization as the primary obstacle to national health insurance. The evidence supports the argument that powerful stakeholder groups, first the American Medical Association, then organizations of insurance companies and employer groups, have been able to defeat every effort to enact national health insurance across an entire century because they had superior resources and an organizational structure that closely mirrored the federated arrangements of the American state. The exception occurred when the AFL-CIO, with its national leadership, state federations and union locals, mobilized on behalf of Medicare. [ABSTRACT FROM AUTHOR]

This paper examines the impact of changes in the medical marketplace on medicalization in U S. society. Using four cases (Viagra, Paxil, human growth hormone and in vitro fertilization), we focus on two aspects of the changing medical marketplace: the role of direct-to-consumer advertising of prescription drugs and the emergence of private medical markets. We demonstrate how consumers and pharmaceutical corporations contribute to medicalization, with physicians, insurance coverage, and changes in regulatory practices playing facilitating roles. In some cases, insurers attempt to counteract medicalization by restricting access. We distinguish mediated and private medical markets, each characterized by differing relationships with corporations, insurers, consumers, and physicians. In the changing medical environment, with medical markets as intervening factors, corporations and insurers are becoming more significant determinants in the medicalization process. [ABSTRACT FROM AUTHOR]

Inmates with a history of opiate dependence represent a substantial proportion of the correctional population in the United States. Opiate use has negative consequences for both the inmate and society, including increased recidivism rates, increased infectious disease prevalence, avoidable emergency room use, decreased access to primary care services, and overdose. While there have been great successes in community-based treatment of opiate' dependence, these successes have not yet been achieved in correctional settings. This paper reviews the pharmacological treatment options for opiate-dependent inmates, along with potential application for community-to-correctional approaches. The recent approval by the Food and Drug Administration (FDA) of physician-prescribed buprenorphine and the new opportunities it presents to' corrections-based treatment are also explored in depth. Successful implementation of such strategies is likely to result in desirable health and social outcomes for both the inmate and the community at large. [ABSTRACT FROM AUTHOR]

This paper describes the origins and development of the sociology of health and illness in Britain and shows that these were rooted in practical concerns, rather than deriving from sociological theory or general sociology. Medical practitioners and researchers, health administrators, patients and the feminist movement have been influences encouraging sociologists to turn their attention to health and illness. The present state of the sub-discipline is one of great activity, but little theoretical or methodological unity. The contribution to the subject of Parsons, Freidson and Mechanic, the marxists, the British post-Fabians, empiricists and phenomenologists are discussed, as is the contribution of the subdiscipline to health and health policy research. In considering the future of the subject, a sociology of health and illness rather than of medicine is proposed and the inevitable moral and political implications of sociological activity in this area are exposed. The need to face the implications of suffering for social relations in health care and the tendency to ignore these is discussed. The wide-ranging importance of the sociology of health and illness to general sociology is stressed and its potential contribution to health and health policy assessed [ABSTRACT FROM AUTHOR]

This paper reviews various theoretical perspectives on organizational change which have been and could be applied to medical organizations. These perspectives are discussed as both filters influencing our observations (research) and mirrors of the shifting dynamics of delivery system reform (policy). We conclude with an examination of how such theories can provide useful insights into our rapidly changing health care system. [ABSTRACT FROM AUTHOR]

The Universitas 21 (U21) organization funded a one-year project to examine global e-health. An e-health steering committee surveyed the opinions of e-health researchers at U21 member schools and conducted a literature review. Information about key themes was analysed and the findings were summarized. The steering committee recommended an eight-step strategy to establish a sustainable endeavour in global e-health. This included implementing a dissemination strategy within the U21 organization to engage a progressively larger community of faculty members and others, and translating e-health knowledge into global practice in those areas in which the U21 has special expertise. While the recommendations in the discussion paper are specific to the U21 organization, the e-health steering committee believes they can be generalized and applied to any globally minded educational or research institutions seeking to contribute to e-health. [ABSTRACT FROM AUTHOR]

The author expresses his views on a paper presented by Carr et al. on the Second Australian National Survey of High Impact Psychosis (SHIP) and also comments on other research on psychiatric care coming from Australia. He opines that questions such as what are the needs of clients, what services are being provided, to how many are being provided these services, what are their impacts and how well are client's objectives being met are fundamental.