scholarly journals Are weak or negative clinical recommendations associated with higher geographical variation in utilisation than strong or positive recommendations? Cross-sectional study of 24 healthcare services

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044090
Author(s):  
Agne Ulyte ◽  
Wenjia Wei ◽  
Oliver Gruebner ◽  
Caroline Bähler ◽  
Beat Brüngger ◽  
...  
Keyword(s):  
Geographical Variation ◽  
Multilevel Models ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Future Research ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mandatory Health Insurance ◽  
The Difference ◽  
Unwarranted Variation

ObjectivesWhen research evidence is lacking, patient and provider preferences, expected to vary geographically, might have a stronger role in clinical decisions. We investigated whether the strength or the direction of recommendation is associated with the degree of geographic variation in utilisation.DesignIn this cross-sectional study, we selected 24 services following a comprehensive approach. The strength and direction of recommendations were assessed in duplicate. Multilevel models were used to adjust for demographic and clinical characteristics and estimate unwarranted variation.SettingObservational study of claims to mandatory health insurance in Switzerland in 2014.ParticipantsEnrolees eligible for the 24 healthcare services.Primary outcome measuresThe variances of regional random effects, also expressed as median odds ratios (MOR). Services grouped by strength and direction of recommendations were compared with Welch’s t-test.ResultsThe sizes of the eligible populations ranged from 1992 to 409 960 patients. MOR ranged between 1.13 for aspirin in secondary prevention of myocardial infarction to 1.68 for minor surgical procedures performed in inpatient instead of outpatient settings. Services with weak recommendations had a negligibly higher variance and MOR (difference in means (95% CI) 0.03 (−0.06 to 0.11) and 0.05 (−0.11 to 0.21), respectively) compared with strong recommendations. Services with negative recommendations had a slightly higher variance and MOR (difference in means (95% CI) 0.07 (−0.03 to 0.18) and 0.14 (−0.06 to 0.34), respectively) compared with positive recommendations.ConclusionsIn this exploratory study, the geographical variation in the utilisation of services associated with strong vs weak and negative vs positive recommendations was not substantially different, although the difference was somewhat larger for negative vs positive recommendations. The relationships between the strength or direction of recommendations and the variation may be indirect or modified by other characteristics of services. As initiatives discouraging low-value care are gaining attention worldwide, these findings may inform future research in this area.

scholarly journals Results of a Patient Reported Experience Measure (PREM) to measure the rare disease patients and caregivers experience: a Spanish cross-sectional study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Mercedes Guilabert ◽  
Alba Martínez-García ◽  
Marina Sala-González ◽  
Olga Solas ◽  
José Joaquín Mira
Keyword(s):  
Rare Disease ◽  
Rare Diseases ◽  
Healthcare Services ◽  
Paediatric Population ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Optimal Care ◽  
Cross Sectional ◽  
Patient Reported ◽  
Mean Time

Abstract Objective To measure the experience of the person having a rare disease in order to identify objectives for optimal care in the health care received by these patients. Methods. A cross-sectional study was conducted in Spain involving patients associated with the Spanish Rare Diseases Federation [Federación Española de Enfermedades Raras] (FEDER). A modified version of the PREM IEXPAC [Instrumento para evaluar la Experiencia del Paciente Crónico] instrument was used (IEXPAC-rare-diseases). Scores ranged between 0 (worst experience) and 10 (best experience). Results A total of 261 caregivers (in the case of paediatric population) and patients with rare diseases (response rate 54.4%) replied. 232 (88.9%) were adult patients and 29 (11.1%) caregivers of minor patients. Most males, 227 (87%), with an average age of 38 (SD 13.6) years. The mean time since confirmation of diagnosis was 7.8 (SD 8.0) years. The score in this PREM was 3.5 points out to 10 (95%CI 3.2–3.8, SD 2.0). Caregivers of paediatric patients scored higher, except for coordination of social and healthcare services. Conclusions There are wide and important areas for improvement in the care of patients with rare diseases. This study involves a first assesment of the experience of patients with rare diseases in Spain.

Enhancing family nursing practice in schools: School nurses’ perspectives on illness beliefs and family nursing practice skills when caring for children with attention-deficit hyperactivity disorder or asthma – A cross-sectional study

2021 ◽  
pp. 205715852110096
Author(s):  
Erla Kolbrun Svavarsdottir ◽  
Gudny Bergthora Tryggvadottir ◽  
Margret Gisladottir ◽  
Ragnheidur Osk Erlendsdottir
Keyword(s):  
Nursing Practice ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
School Nurses ◽  
Illness Beliefs ◽  
Sectional Study ◽  
Cross Sectional ◽  
Hyperactivity Disorder ◽  
Family Nursing ◽  
Practice Skills

An increasing number of children attend schools with chronic illnesses/disorders that require managing and comprehensive healthcare from school nurses during the day. Collaboration between school nurses, the school-aged child with attention-deficit hyperactivity disorder (ADHD) or asthma, and their families is needed when coordinating/managing chronic health problems in the school setting. However, involving families in the assessment and care planning processes can be challenging. The aim of this study was to survey the illness beliefs of school nurses and their perceptions of their family nursing practice skills when offering healthcare services to children with ADHD or asthma in schools. A cross-sectional study was used for a sample of 82 school nurses. The manuscript was prepared following STROBE guidelines. Results indicated that the school nurses perceived themselves to be more confident and to have better knowledge and skill in family nursing practice when offering healthcare services to families of children with ADHD in comparison to asthma.

scholarly journals Media consumption and mental health during COVID-19 lockdown: a UK cross-sectional study across England, Wales, Scotland and Northern Ireland

2021 ◽  
Author(s):  
Ruth D Neill ◽  
Carolyn Blair ◽  
Paul Best ◽  
Emily McGlinchey ◽  
Cherie Armour
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Media Exposure ◽  
Cross Sectional Study ◽  
Anxiety And Depression ◽  
Future Research ◽  
Media Consumption ◽  
Sectional Study ◽  
Cross Sectional ◽  
Longitudinal Data Collection

Abstract Aim As individuals adjust to new ‘norms’ and ways of living during the COVID-19 lockdown, there is a continuing need for up-to-date information and guidance. Evidence suggests that frequent media exposure is related to a higher prevalence of mental health problems, especially anxiety and depression. The aim of this study was to determine whether COVID-19 related media consumption is associated with changes in mental health outcomes. Methods This paper presents baseline data from the COVID-19 Psychological Wellbeing Study. The cross-sectional study data was collected using an online survey following the Generalised Anxiety Disorder scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), with some other basic information collected. Logistic regression analysis was used to examine the influence of socio-demographic and media specific factors on anxiety and depression. Results The study suggested that media usage is statistically significantly associated with anxiety and depression on the GAD-7 and PHQ-9 scales with excessive media exposure related to higher anxiety and depression scores. Conclusion This study indicated that higher media consumption was associated with higher levels of anxiety and depression. Worldwide it should be acknowledged that excessive media consumption, particularly social media relating to COVID-19, can have an effect on mental health. However, as this was a cross-sectional study we cannot infer any directionality as we cannot infer cause and effect; therefore, future research involving longitudinal data collection and analyses of variables over time is warranted.

scholarly journals Evaluation of e-health (Seha) application: a cross-sectional study in Saudi Arabia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abeer Alharbi ◽  
Joharah Alzuwaed ◽  
Hind Qasem
Keyword(s):  
Saudi Arabia ◽  
Health Services ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Advanced Technology ◽  
Sectional Study ◽  
Cross Sectional ◽  
Technical Problems ◽  
Significant Difference ◽  
Ease Of Access

Abstract Background The Ministry of Health in Saudi Arabia is expanding the country’s telemedicine services by using advanced technology in health services. In doing so, an e-health application (app), Seha, was introduced in 2018 that allows individuals to have face-to-face visual medical consultations with their doctors on their smartphones. Objective This study evaluated the effectiveness of the app in improving healthcare delivery by ensuring patient satisfaction with the care given, increasing access to care, and improving efficiency in the healthcare system. Methods A cross-sectional study design was used to assess the perceptions of users of the Seha app and non-users who continued with traditional health services. The data were collected using an online survey via Google Forms between June 2020 and September 2020. Independent t tests and chi-square (χ2) tests were conducted to answer the research questions. Results There was a significant difference between users and non-users in terms of ease of access to health services (t =  − 9.38, p < 0.05), with app users having a higher mean score (4.19 ± 0.91) than non-users (3.41 ± 1.00); satisfaction with health services (t =  − 6.33, p < 0.05), with users having a higher mean score (3.96 ± 0.91) than non-users (3.45 ± 0.94); and efficiency (only one visit needed for treatment) (t =  − 3.20, p < 0.05), with users having a higher mean score (3.71 ± 0.93) than non-users (3.45 ± 0.93). There were significant associations between the use of the Seha app and age (χ2 = 8.79, p < 0.05), gender (χ2 = 22.19, p < 0.05), region (χ2 = 19.74, p < 0.05), and occupation (χ2 = 22.05, p < 0.05). There were significant relationships between the three items (on access, satisfaction, and efficiency) and experiencing technical issues (t = 4.47, t = 8.11, and t = 3.24, respectively, p < 0.05), with users who faced technical problems having significantly lower mean scores for all three items. Conclusion This study provided evidence that the Seha app improved the delivery of healthcare in Saudi Arabia. Users of the app had a better health experience in terms of their perceived ease of access to healthcare services; their satisfaction with healthcare services; and the efficiency of the system, measured by the number of required doctor visits. Other factors that appeared to influence the use of the app included age, gender, usual source of care, and technical difficulties.

scholarly journals Patients’ Perspectives about Lifestyle Behaviors and Health in the Context of Family Medicine: A Cross-Sectional Study in Portugal

2021 ◽  
Vol 18 (6) ◽  
pp. 2981
Author(s):  
Rosália Páscoa ◽  
Andreia Teixeira ◽  
Micaela Gregório ◽  
Rosa Carvalho ◽  
Carlos Martins
Keyword(s):  
Family Medicine ◽  
Family Doctor ◽  
Cross Sectional Study ◽  
Demographic Variables ◽  
Future Research ◽  
Lifestyle Behaviors ◽  
Sectional Study ◽  
Self Assessment ◽  
Cross Sectional ◽  
The Family

Lifestyle interventions are recognized as essential in the prevention and treatment of non-communicable diseases. Previous studies have shown that Portuguese patients tend to give more importance to diagnostic and laboratory tests than to lifestyle measures, and seem unaware that behavioral risks are the main modifiable risk factors. The study aimed to analyze patients’ perspectives about lifestyle behaviors and health in the context of family medicine in Portugal. A population-based cross-sectional study was carried out in Portugal (the mainland). A total of 900 Portuguese patients aged ≥20 years, representative of the population, were surveyed using face-to-face questionnaires. Participants were selected by the random route method. Descriptive statistics and non-parametric tests were performed to evaluate differences between the personal beliefs and the personal behavior self-assessment, as well as between the level of importance given to the family doctor to address health behaviors and the reported approach implemented by the family doctor, and its association with bio-demographic variables. The results indicate that the vast majority of this Portuguese cohort has informed beliefs regarding lifestyle behaviors, tends to overestimate their own behavior self-assessment, and strongly agrees that it is important that their family doctor asks/advises on these lifestyle behaviors, although the proportion of those who totally agree that their family doctor usually does this is significantly lower. Differences concerning bio-demographic variables were found. Future research directions should focus on the politics, economics, and policy aspects that may have an impact in this area. It will also be important to understand more broadly the relationships between lifestyle behaviors and clinical, physical, and sociodemographic variables.

Prevalence of parental mental health conditions among children aged 0–16 years in Denmark: A nationwide register-based cross-sectional study

2021 ◽  
pp. 140349482110454
Author(s):  
Amanda M.S. Christesen ◽  
Camilla K. Knudsen ◽  
Kirsten Fonager ◽  
Martin N. Johansen ◽  
Signe Heuckendorff
Keyword(s):  
Mental Health ◽  
Geographical Variation ◽  
Cross Sectional Study ◽  
Health Condition ◽  
Health Conditions ◽  
Mental Health Condition ◽  
Sectional Study ◽  
Parental Mental Health ◽  
Cross Sectional ◽  
Mental Health Conditions

Aim: Parental mental health conditions adversely affect the children. Information on the prevalence of parental mental health conditions is needed to help policymakers allocate resources appropriately. Therefore, the aim of this study was to estimate the prevalence of children with parental mental health conditions in Denmark and further estimate the age-specific prevalence and geographical variation. Methods: In this nationwide register-based cross-sectional study, we included all children born between 2000 and 2016 if they resided in Denmark on 31 December 2016. Information on both maternal and paternal mental health conditions was retrieved from primary and secondary healthcare registers. Parental mental health conditions were categorised in three severity groups: minor, moderate, and severe. We estimated the proportion of children with parental mental health conditions on 31 December 2016. Results: Of the 1,106,459 children aged 0–16 years, 39.1% had at least one parent with a mental health condition. The prevalence increased with age of the children until the age of six years. Geographical variation in the prevalence ranged from 29.0% to 48.3% in the 98 municipalities. Minor parental mental health conditions (23.5%) were more common than moderate (13.5%) and severe parental mental health conditions (2.2%). Hospital-diagnosed parental mental health conditions were prevalent in 12.8% of the children. Conclusions: Two in five children aged 0–16 years in Denmark have parents with a mental health condition and geographical variation exists. The high prevalence of children with parental mental health conditions is an important public health challenge, which calls for attention.

scholarly journals The hope of women with HIV/AIDS: evaluation using the Herth Scale

2013 ◽  
Vol 22 (1) ◽  
pp. 141-148 ◽  
Author(s):  
Fabiana de Souza Orlandi ◽  
Neide de Souza Praça
Keyword(s):  
Healthcare Services ◽  
Cross Sectional Study ◽  
Ethics Committee ◽  
Average Score ◽  
Hiv Positive ◽  
Sectional Study ◽  
Cross Sectional ◽  
Hiv Positive Women ◽  
The City ◽  
Hiv Aids

This descriptive cross-sectional study had the objective to evaluate the level of hope in women aged 50 or older suffering from HIV/AIDS, utilizing the Herth Hope Scale. The study involved 200 HIV- positive women, within the age bracket of interest, enrolled in three STI/AIDS specialized healthcare services in the city of São Paulo. The rules of the 196/96 Resolution were met and the study was approved by the Research and Ethics Committee. Data were collected in 2010 using two instruments: subjects' characterization and the Herth Hope Scale. Results demonstrated an average score of 36.75 (±4.52) on the Herth Hope Scale, with an interval of 12 to 48. This score is below the score obtained with the same scale for various pathologies, indicating a reduced perception of hope by the sample. Nurses should provide interventions to improve hope for these people, establishing realistic goals and strengthening social support.

scholarly journals Study of Maternal and Fetal Outcome among Booked and Unbooked Patients at tertiary Hospital

2020 ◽  
Vol 5 (2) ◽  
pp. 1027-1030
Author(s):  
Shanti Sunuwar Subedi ◽  
Rakina Bhansakarya ◽  
Sajjan Kumar Sharma
Keyword(s):  
Sampling Technique ◽  
Secondary Level ◽  
Tertiary Hospital ◽  
Fetal Outcome ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Spontaneous Vaginal Delivery ◽  
Significant Difference ◽  
The Difference

Introduction: To evaluate the maternal and perinatal outcome in booked and unbooked cases. Objectives: To assess the maternal and fetal outcomes in unbooked and booked patients. Methodology: This was a cross-sectional comparative study conducted in the Department of Obstetrics and Gynecology from Augustti2019 to January 2020. Using a convenient sampling technique, 204 samples were taken and cross-sectional study was done. Results: There were total 204 cases in this study;102were booked and 102 were unbooked. In this study, 85(83%) of booked cases were educated up to secondary level as compared toti65 (64%) of unbooked cases. There was no significant difference in Apgar score in 1 and 5 minute between booked and unbooked cases. More babies in the unbooked group were transferred to NICU as compared to the booked group and the difference was significant (9.8%vs 1.9%). Greater proportion of booked cases had spontaneous vaginal delivery (81.3% vs 59.8%) and complications like preterm delivery, anemia, preeclampsia/ eclampsia, complicated labor and puerperal sepsis was also less in the booked group. Conclusions: The study showed that unbooked mothers and their newborns had higher chance of having complications.

scholarly journals PREVALENCE OF IRON DEFICIENCY ANEMIA IN ADOLESCENT GIRLS IN JAIPUR DISTRICT: A CROSS SECTIONAL STUDY

2021 ◽  
Vol 12 (1) ◽  
pp. 48-52
Author(s):  
Priyanka Kumari ◽  
Nisha Kumari Ojha
Keyword(s):  
Adolescent Girls ◽  
Low Socioeconomic Status ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Family Type ◽  
Deficiency Anemia ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Iron Folic Acid

Globally anemia accounts for a majority of the nutritional problem and it is principally engendered by deficiency of iron. Its prevalence is inordinately higher among developing nations, because of low socioeconomic status and poor access to healthcare services. In developing countries, the adolescent group is more exposed to nutritional challenges and adolescent girls are more vulnerable to the disease. This survey is intended to evaluate the prevalence of anemia and its associated factors among adolescent girls in age group of 12-15 year in Jaipur district, this survey also generated the anemic cases in the adolescent girls of age 12-15 year. A cross sectional study was conducted from August 2019 to January 2020 by attending health check-up camps at various areas situated within 20 kilometers in Jaipur district. Hemoglobin estimation was done by using three-part auto analyzer method. Statistical analysis was done using Percentages and Chi-square Test. 75.39% girls were found anemic. Statistically significant association (p < 0.05) was found in anemia in adolescent girls with the history of receiving iron folic acid (IFA) supplementation, deworming, age, habitat, family type and status of menarche. Present study reveals that 75.39% girls were found anemic and the problem is significantly associated with status of IFA supplementation, deworming and family type.

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