scholarly journals A Risk Exchange: Health and Mobility in the Context of Climate and Environmental Change in Bangladesh—A Qualitative Study

2021 ◽  
Vol 18 (5) ◽  
pp. 2629
Author(s):  
Patricia Nayna Schwerdtle ◽  
Kate Baernighausen ◽  
Sayeda Karim ◽  
Tauheed Syed Raihan ◽  
Samiya Selim ◽  
...  
Keyword(s):  
Climate Change ◽  
Mental Health ◽  
Quality Of Care ◽  
Health Risks ◽  
Thematic Analysis ◽  
Health Determinants ◽  
Physical And Mental Health ◽  
Health And Wellbeing ◽  
Healthcare Environment

Background: Climate change influences patterns of human mobility and health outcomes. While much of the climate change and migration discourse is invested in quantitative predictions and debates about whether migration is adaptive or maladaptive, less attention has been paid to the voices of the people moving in the context of climate change with a focus on their health and wellbeing. This qualitative research aims to amplify the voices of migrants themselves to add nuance to dominant migration narratives and to shed light on the real-life challenges migrants face in meeting their health needs in the context of climate change. Methods: We conducted 58 semi-structured in-depth interviews with migrants purposefully selected for having moved from rural Bhola, southern Bangladesh to an urban slum in Dhaka, Bangladesh. Transcripts were analysed using thematic analysis under the philosophical underpinnings of phenomenology. Coding was conducted using NVivo Pro 12. Findings: We identified two overarching themes in the thematic analysis: Firstly, we identified the theme “A risk exchange: Exchanging climate change and health risks at origin and destination”. Rather than describing a “net positive” or “net negative” outcome in terms of migration in the context of climate change, migrants described an exchange of hazards, exposures, and vulnerabilities at origin with those at destination, which challenged their capacity to adapt. This theme included several sub-themes—income and employment factors, changing food environment, shelter and water sanitation and hygiene (WaSH) conditions, and social capital. The second overarching theme was “A changing health and healthcare environment”. This theme also included several sub-themes—changing physical and mental health status and a changing healthcare environment encompassing quality of care and barriers to accessing healthcare. Migrants described physical and mental health concerns and connected these experiences with their new environment. These two overarching themes were prevalent across the dataset, although each participant experienced and expressed them uniquely. Conclusion: Migrants who move in the context of climate change face a range of diverse health risks at the origin, en route, and at the destination. Migrating individuals, households, and communities undertake a risk exchange when they decide to move, which has diverse positive and negative consequences for their health and wellbeing. Along with changing health determinants is a changing healthcare environment where migrants face different choices, barriers, and quality of care. A more migrant-centric perspective as described in this paper could strengthen migration, climate, and health governance. Policymakers, urban planners, city corporations, and health practitioners should integrate the risk exchange into practice and policies.

Quality of care in longer term mental health institutions in Portugal

2011 ◽  
Vol 38 (S 01) ◽  
Author(s):  
G Cardoso ◽  
C Pacheco ◽  
J Caldas-de-Almeida
Keyword(s):  
Mental Health ◽  
Quality Of Care ◽  
Health Institutions ◽  
Mental Health Institutions

scholarly journals Physical Inactivity in Older Adult Couples: A Dyadic Analysis Using Continuous In-Home Monitoring

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 412-412
Author(s):  
Chao-Yi Wu ◽  
Lyndsey Miller ◽  
Rachel Wall ◽  
Zachary Beattie ◽  
Jeffrey Kaye ◽  
...  
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Older Adult ◽  
Physical Inactivity ◽  
Home Monitoring ◽  
Health Determinants ◽  
Dyadic Analysis ◽  
Physical And Mental Health ◽  
Positive Health ◽  
Aging Research

Abstract Many older adults remain inactive despite the known positive health implications of physical activity (e.g. improved mood, reduced mortality risk). Physical inactivity is a known interdependent phenomenon in couples, but the majority of research identifies determinants of physical inactivity at the individual level. We estimated the average amount of physical inactivity for older adult couples and, using dyadic analysis, identified physical and mental health determinants thereof. Forty-eight heterosexual older adult couples (mean age=70.6, SD=6.63) from the Veterans Integrated Service Network 20 cohort of the Collaborative Aging Research using Technology (CART) initiative were included in this study. Both dyad members wore actigraph devices for a month. The average number per day of inactive periods (defined as no movement or sleep activity for ≥ 30 minutes) was estimated. Multilevel modeling revealed that, within couples, there was no difference between partners in the average number of inactive periods, but on average across couples, males had more inactive periods per day (13.4, SD=4.43) than females (12.3, SD=4.87). For males, older age was the only variable associated with more inactive periods (β=0.13, p=.013). For females, more depressive symptoms in men were associated with fewer inactive periods (β=-0.37, p=.002), and more dependence in completing their own IADLs predicted more inactive periods (β=2.80, p<.001). All models were adjusted for covariates. Viewing couples’ activity as a unit, rather than as separate individuals, provides a novel approach to identifying pathways to reduce inactivity in older adults, especially when focusing on mental health issues and decreased independence within the couple.

scholarly journals Satisfaction With Health Care by Dual Sensory Impairment Status

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 798-798
Author(s):  
Lama Assi ◽  
Ahmed Shakarchi ◽  
Bonnielin Swenor ◽  
Nicholas Reed
Keyword(s):  
Quality Of Care ◽  
Healthcare Providers ◽  
Health Determinants ◽  
Sensory Impairment ◽  
Medicare Beneficiaries ◽  
The Past ◽  
Patient Provider Communication ◽  
Care Satisfaction ◽  
Dual Sensory Impairment

Abstract Sensory impairment is a barrier to patient-provider communication and access to care, which may impact satisfaction with care. Satisfaction with the quality of care received in the past year was assessed in the 2017 Medicare Current Beneficiary Survey (weighted sample=53,905,182 Medicare beneficiaries). Self-reported sensory impairment was categorized as no sensory impairment, hearing impairment (HI)-only, vision impairment (VI)-only, and dual sensory impairment (DSI) – concurrent HI and VI. In a model adjusted for sociodemographic characteristics and health determinants, having DSI was associated with higher odds of dissatisfaction with the quality of care received (Odds Ratio [OR]=1.53, 95%Confidence Interval [CI]=1.14-2.06) relative to no sensory impairment; however, having HI-only or VI-only were not (OR=1.33, 95%CI=1.94-1.89, and OR=1.32, 95%CI=0.95-1.93, respectively). These findings have implications for healthcare providers as Medicare shifts to value-based reimbursement. Moreover, previous work that singularly focused on HI or VI alone may have failed to recognize the compounded effect of DSI.

scholarly journals Sleep Disorders in Adults with Down Syndrome

2021 ◽  
Vol 10 (14) ◽  
pp. 3012
Author(s):  
Sandra Giménez ◽  
Miren Altuna ◽  
Esther Blessing ◽  
Ricardo M. Osorio ◽  
Juan Fortea
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Down Syndrome ◽  
Sleep Disorders ◽  
Negative Impact ◽  
Current Knowledge ◽  
Sleep Disruption ◽  
Physical And Mental Health ◽  
Future Directions

Sleep disorders, despite being very frequent in adults with Down syndrome (DS), are often overlooked due to a lack of awareness by families and physicians and the absence of specific clinical sleep guidelines. Untreated sleep disorders have a negative impact on physical and mental health, behavior, and cognitive performance. Growing evidence suggests that sleep disruption may also accelerate the progression to symptomatic Alzheimer’s disease (AD) in this population. It is therefore imperative to have a better understanding of the sleep disorders associated with DS in order to treat them, and in doing so, improve cognition and quality of life, and prevent related comorbidities. This paper reviews the current knowledge of the main sleep disorders in adults with DS, including evaluation and management. It highlights the existing gaps in knowledge and discusses future directions to achieve earlier diagnosis and better treatment of sleep disorders most frequently found in this population.

scholarly journals Guided Self-help Teletherapy for Behavioural Difficulties in Children with Epilepsy

2021 ◽  
Author(s):  
Sophie Bennett ◽  
Isobel Heyman ◽  
Sophia Varadkar ◽  
Anna Coughtrey ◽  
Fahreen Walji ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Unmet Need ◽  
Hospital Setting ◽  
Physical And Mental Health ◽  
Paediatric Hospital ◽  
Complex Needs ◽  
Self Help ◽  
Behavioural Difficulties

AbstractBehavioural difficulties impact greatly upon quality of life for children with chronic illness and their families but are often not identified or adequately treated, possibly due to the separation of physical and mental health services. This case study describes the content and outcomes of guided self-help teletherapy for behavioural difficulties in a child with epilepsy and complex needs using an evidence-based behavioural parenting protocol delivered within a paediatric hospital setting. Behavioural difficulties and progress towards the family’s self-identified goals were monitored at each session. Validated measures of mental health and quality of life in children were completed before and after intervention and satisfaction was measured at the end of treatment. Measures demonstrated clear progress towards the family’s goals and reduction in weekly ratings of behavioural difficulties. This case demonstrates that a guided self-help teletherapy approach delivered from within the paediatric setting may be one way of meeting unmet need.

scholarly journals Quality of care indicators for schizophrenia: determinants of observed variations among Italian Departments of Mental Health. Results from the ETAS DSM study

2016 ◽  
Vol 26 (3) ◽  
pp. 299-313 ◽  
Author(s):  
G. Fantini ◽  
G. Tibaldi ◽  
P. Rucci ◽  
D. Gibertoni ◽  
M. Vezzoli ◽  
...  
Keyword(s):  
Mental Health ◽  
Quality Of Care ◽  
Health Care Professionals ◽  
Treatment Guidelines ◽  
Psychosocial Rehabilitation ◽  
Metabolic Effects ◽  
Administrative Databases ◽  
Pharmacological Intervention ◽  
Pharmacological Interventions

Aims.The primary aim of this study is to analyse the conformance of usual care patterns for persons with schizophrenia to treatment guidelines in three Italian Departments of Mental Health (DMHs). The secondary aim is to examine possible organisational and structural reasons accounting for variations among DMHs.Methods.Within the framework of the Evaluation of Treatment Appropriateness in Schizophrenia (ETAS) project, 20 consensus quality of care indicators were developed. Ten concerned pharmacological treatment and ten encompassed general care and psychosocial rehabilitation interventions. Indicators were calculated using data from a stratified random sample of 458 patients treated at three DMHs located in North-Eastern, North-Western and Southern Italy. Patients’ data were collected by combining information from medical charts and from a survey carried out by the health care professionals in charge of the patients. Data on the structural and organisational characteristics of the DMHs were retrieved from administrative databases. For each indicator, the number and percentage of appropriate interventions with and without moderators were calculated. Appropriateness was defined as the percentage of eligible patients receiving an intervention conformant with guidelines. Moderators, i.e., reasons justifying a discrepancy between the interventions actually provided and that recommended by guidelines were recorded. Indicators based on a sufficient number of eligible patients were further explored in a statistical analysis to compare the performance of the DMHs.Results.In the overall sample, the percentage of inappropriate interventions ranged from 11.1 to 59.3% for non-pharmacological interventions and from 5.9 to 66.8% for pharmacological interventions. Comparisons among DMHs revealed significant variability in appropriateness for the indicators ‘prevention and monitoring of metabolic effects’, ‘psychiatric visits’, ‘psychosocial rehabilitation’, ‘family involvement’ and ‘work’. After adjusting the patient's gender, age and functioning, only the indicators ‘Prevention and monitoring of metabolic effects’, ‘psychiatric visits’ and ‘work’ continued to differ significantly among DMHs. The percentage of patients receiving appropriate integrated care (at least one appropriate non-pharmacological intervention and one pharmacological intervention) was significantly different among the three DMHs and lower than expected.Conclusions.Our results underscore discrepancies among Italian DMHs in indicators that explore key aspects of care of patients with schizophrenia. The use of quality indicators and improved guideline adherence can address suboptimal clinical outcomes, and has the potential to reduce practice variations and narrow the gap between optimal and routine care.

Guidelines for Adapting Mindfulness-Based School Interventions with Underserved Youth

2021 ◽  
Author(s):  
Mary Lynd Phan ◽  
Tyler L Renshaw
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Disparities ◽  
Quality Of Care ◽  
Health Services ◽  
Social Emotional ◽  
Emotional Competencies ◽  
Underserved Youth ◽  
Diverse Youth

Low-income and ethnically diverse youth in the United States have unmet needs for mental health services; however, these same youth are unlikely to be connected with high-quality mental health care. Promoting social-emotional competencies through school-based service delivery is one potential solution for improving the accessibility and quality of care for diverse youth facing mental health disparities. Mindfulness, conceived as a set of practices to cultivate social-emotional competencies, can therefore be useful for improving the accessibility and quality of care for diverse youth facing mental health disparities. Given the growing interest in MBSIs and the need to enhance equity in youth mental health services more generally, we provide guidelines to help practicing clinicians successfully adapt and implement MBSIs with underserved youth. First, we offer recommendations for clinicians to enhance underserved youths’ engagement with MBSIs. Next, we overview implementation approaches that clinicians could use for increasing access to MBIs in school settings. Following, we discuss strategies clinicians might employ when working with teachers to effectively implement MBSIs with underserved youth in their classrooms. Ultimately, we hope the guidelines offered in this paper might help inform better practice—as well as motivate further, better research—that advances equitable mental health care in schools with underserved youth.

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