The Relational Vulnerability of People Experiencing Multiple Exclusion Homelessness (MEH) in Spain

This paper draws on research analyzing the emotional and relational impacts of poverty and exclusion on charities’ clients in Spain since the 2008–2009 economic crisis, including people experiencing multiple exclusion homelessness (MEH). The study adopts a mixed-methods approach in which twenty in-depth cases were collected in different geographical locations, including twelve cases experiencing MEH. Unlike other disadvantaged groups, those affected by MEH suffer material shortages, traumatic experiences, psychological disorders, physical illnesses, and a high degree of relational vulnerability, as reflected in the structure and composition of their personal networks, which tend to be smaller in size, with just a few weak and temporary contacts, and with care professionals playing an important role. These charity users often need long-term socio-sanitary care, which challenges public and private health-care systems. Therefore, our contribution to this Special Issue is directed toward improving understanding of the relational characteristics of severely excluded people, how social support affects their personal networks, and the challenges this assistance poses to care services.

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Hallucinogenic/psychedelic 5HT2A receptor agonists as rapid antidepressant therapeutics: Evidence and mechanisms of action

Journal of Psychopharmacology ◽

10.1177/0269881120986422 ◽

2021 ◽

pp. 026988112098642

Author(s):

Rafael Guimarães dos Santos ◽

Jaime EC Hallak ◽

Glen Baker ◽

Serdar Dursun

Keyword(s):

Health Care Systems ◽

Treatment Compliance ◽

Therapeutic Effects ◽

Beneficial Effects ◽

Antidepressant Effects ◽

Care Systems ◽

Drug Treatments ◽

Fast Acting

Major depressive disorder (MDD) is among the most prevalent mental health disorders worldwide, and it is associated with a reduced quality of life and enormous costs to health care systems. Available drug treatments show low-to-moderate response in most patients, with almost a third of patients being non-responders (treatment-resistant). Furthermore, most currently available medications need several weeks to achieve therapeutic effects, and the long-term use of these drugs is often associated with significant unwanted side effects and resultant reductions in treatment compliance. Therefore, more effective, safer, and faster-acting antidepressants with enduring effects are needed. Together with ketamine, psychedelics (or classic or serotoninergic hallucinogens) such as lysergic acid diethylamide (LSD), psilocybin, and ayahuasca are among the few compounds with recent human evidence of fast-acting antidepressant effects. Several studies in the 1950s to 1970s reported antidepressive and anxiolytic effects of these drugs, which are being confirmed by modern trials (LSD, one trial; psilocybin, five trials; ayahuasca, two trials). The effects of these drugs appear to be produced primarily by their agonism at serotonin (5-hydroxytryptamine, 5-HT) receptors, especially the 5-HT2A receptor. Considering the overall burden of MDD and the necessity of new therapeutic options, the promising (but currently limited) evidence of safety and efficacy of psychedelics has encouraged the scientific community to explore more fully their beneficial effects in MDD.

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Long-term hospital attendance of children and adults who have undergone removal of normal or inflamed appendices

The British Journal of Psychiatry ◽

10.1192/bjp.181.6.526 ◽

2002 ◽

Vol 181 (6) ◽

pp. 526-530 ◽

Cited By ~ 3

Author(s):

Nicola J. Dummett ◽

Nicola J. Maughan ◽

Anne Worrall-Davies

Keyword(s):

Health Care ◽

Health Care Systems ◽

Attendance Rates ◽

Liaison Psychiatry ◽

Abdominal Symptoms ◽

Secondary Health Care ◽

Care Systems ◽

Self Harm ◽

Males And Females

BackgroundEarly studies suggested that presentations with unexplained acute abdominal pain were associated with increased long-term rates of hospital attendance and self-harm, especially in women, but few studies were large enough for definitive findings.AimsTo test the hypothesis that such presentations are followed by higher long-term utilisation rates of secondary health care even excluding further abdominal symptoms, and particularly for self-harm, than presentations with acute appendicitis.MethodNew hospital attendance rates, liaison psychiatry attendances and self-harm attendances of patients with normal appendices at emergency appendicectomy were compared with those of appendicitis patients.ResultsAttendance rates of all kinds were significantly higher for normal appendix patients than for appendicitis patients, with equal strengths of finding for males and females.ConclusionsPeople with normal appendices at emergency appendicectomy show higher long-term rates of hospital attendance. This has implications for how these patients are best managed by health care systems.

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Future Perspectives of Health Care: Closing Remarks

Health Promotion in Health Care – Vital Theories and Research ◽

10.1007/978-3-030-63135-2_26 ◽

2021 ◽

pp. 375-380

Author(s):

Gørill Haugan ◽

Monica Eriksson

Keyword(s):

Health Care ◽

Health Promotion ◽

Health Care Services ◽

Health Care Systems ◽

Health Sector ◽

Care Services ◽

Care Systems ◽

Health Promoting ◽

Professional Leadership ◽

Salutogenic Model

AbstractThe Covid-19 pandemic has demonstrated the vulnerability of our health care systems as well as our societies. During the year of 2020, we have witnessed how whole societies globally have been in a turbulent state of transformation finding strategies to manage the difficulties caused by the pandemic. At first glance, the health promotion perspective might seem far away from handling the serious impacts caused by the Covid-19 pandemic. However, as health promotion is about enabling people to increase control over their health and its determinants, paradoxically health promotion seems to be ever more important in times of crisis and pandemics. Probably, in the future, pandemics will be a part of the global picture along with the non-communicable diseases. These facts strongly demand the health care services to reorient in a health promoting direction.The IUHPE Global Working Group on Salutogenesis suggests that health promotion competencies along with a reorientation of professional leadership towards salutogenesis, empowerment and participation are required. More specifically, the IUHPE Group recommends that the overall salutogenic model of health and the concept of SOC should be further advanced and applied beyond the health sector, followed by the design of salutogenic interventions and change processes in complex systems.

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Public-Private Partnership in Health and Long-Term Care

Sustainable Health and Long-Term Care Solutions for an Aging Population - Advances in Medical Diagnosis, Treatment, and Care ◽

10.4018/978-1-5225-2633-9.ch006 ◽

2018 ◽

pp. 103-124

Author(s):

Wing Tung Ho ◽

Ben Yuk Fai Fong

Keyword(s):

Hong Kong ◽

Long Term Care ◽

Health Care Systems ◽

Public Private Partnership ◽

Term Care ◽

Related Services ◽

Private Partnership ◽

Aging Populations ◽

Care Systems

An exponential growth in elderly population reflects a proportional increase in recourses that are unaffordable and unsustainable to the economy. This rapid demand for health services and long-term care not only leads to non-financial implication like shortage of manpower and long waiting time, but this also creates a large burden on health and related services in the public sector. Involving the private sector to provide better and more efficient facilities and services and to encourage innovation will enhance productivity, speed up project and service delivery, and increase opportunities for investment in health. This chapter examines existing problems within health care systems in aging populations such as Hong Kong, explores the advantages and challenges of Public Private Partnership (PPP), identifies successful factors in establishing PPPs models, reviews the PPP projects in Hong Kong and elsewhere and recommends methods in promoting PPP in health and long-term care as sustainable solutions.

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Journey of the Patient With Melanoma: Understanding Resource Use and Bridging the Gap Between Dermatologist, Surgeon, and Oncologist in Different Health Care Systems

Journal of Global Oncology ◽

10.1200/jgo.19.00022 ◽

2019 ◽

pp. 1-8

Author(s):

Cássia Rita Pereira da Veiga ◽

Claudimar Pereira da Veiga ◽

Ana Paula Drummond-Lage ◽

Alberto Julius Alves Wainstein ◽

Andreia Cristina de Melo

Keyword(s):

Health Care ◽

Decision Making ◽

Health Care Systems ◽

Scientific Evidence ◽

Health Resources ◽

Medical Professionals ◽

Public And Private ◽

Patients With Cancer ◽

Clinical Procedures ◽

Care Systems

PURPOSE New scientific evidence has led to modifications in the clinical practice of handling melanoma. In health care systems, there is currently a wide variety of clinical procedures to treat cancer, and the various routes have different effects on the survival of patients with cancer. Thus, this article aimed to evaluate the journey of patients with melanoma in the public and private health care systems in Brazil from the viewpoint of different medical professionals involved in the diagnosis and treatment of the disease. The study also considers the resources used for the complete delivery cycle of health care at different stages of the evolution of melanoma. METHODS We conducted a behavioral study by applying a questionnaire to a group of medical professionals. A nonprobabilistic sampling method for convenience was used, justified by the heterogeneous national incidence and the limited availability of medical professionals who diagnose and treat melanoma. RESULTS The questionnaire was answered by 138 doctors, including doctors from the Brazilian states with the highest concentration of medical specialists and regions with a higher melanoma incidence. The results of this study have the potential to enrich our understanding of the reality of Brazilian health care systems and, at the same time, allow us to discuss the multiple ways in which professionals from diverse specialist fields understand and explain decision making in health care. CONCLUSION Health care decision making is complex and, among other factors, depends on the diversity of available health resources and the knowledge of which treatments provide the greatest benefit to patients and greatest value to the system as a whole. This work can inform debates and reflection that are applicable not only in Brazil, but also in various other countries with similar realities.

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Older multimorbid patients’ experiences on integration of services: a systematic review

BMC Health Services Research ◽

10.1186/s12913-019-4644-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Lilian Keene Boye ◽

Christian Backer Mogensen ◽

Tine Mechlenborg ◽

Frans Boch Waldorff ◽

Pernille Tanggaard Andersen

Keyword(s):

Health Care ◽

Continuity Of Care ◽

Health Care Services ◽

Health Care Systems ◽

Easy Access ◽

Ageing Population ◽

Health Providers ◽

Care Coordinator ◽

Care Services ◽

Care Systems

Abstract Background Half of the older persons in high-income counties are affected with multimorbidity and the prevalence increases with older age. To cope with both the complexity of multimorbidity and the ageing population health care systems needs to adapt to the aging population and improve the coordination of long-term services. The objectives of this review were to synthezise how older people with multimorbidity experiences integrations of health care services and to identify barriers towards continuity of care when multimorbid. Methods A systematic literature search was conducted in February 2018 by in Scopus, Embase, Cinahl, and Medline using the PRISMA guidelines. Inclusion criteria: studies exploring patients’ point of view, ≥65 and multi-morbid. Quality assessment was conducted using COREQ. Thematic synthesis was done. Results Two thousand thirty studies were identified, with 75 studies eligible for full text, resulting in 9 included articles, of generally accepted quality. Integration of health care services was successful when the patients felt listened to on all the aspects of being individuals with multimorbidity and when they obtained help from a care coordinator to prioritize their appointments. However, they felt frustrated when they did not have easy access to their health providers, when they were not listened to, and when they felt they were discharged too early. These frustrations were also identified as barriers to continuity of care. Conclusions Health care systems needs to adapt to people with multimorbidity and find solutions on ways to create flexible systems that are able to help older patients with multimorbidity, meet their individual needs and their desire to be involved in decisions regarding their care. A Care coordinator may be a solution.

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The making and sustaining of leaders in health care

Journal of Health Organization and Management ◽

10.1108/jhom-07-2018-0210 ◽

2019 ◽

Vol 33 (2) ◽

pp. 241-262 ◽

Cited By ~ 3

Author(s):

Terry J. Boyle ◽

Kieran Mervyn

Keyword(s):

Health Care ◽

Community Health ◽

Health Care Services ◽

Health Care Systems ◽

Structured Interviews ◽

Healthcare Provision ◽

Triple Aim ◽

Content Type ◽

Care Services ◽

Care Systems

Purpose Many nations are focussing on health care’s Triple Aim (quality, overall community health and reduced cost) with only moderate success. Traditional leadership learning programmes have been based on a taught curriculum, but the purpose of this paper is to demonstrate more modern approaches through procedures and tools. Design/methodology/approach This study evolved from grounded and activity theory foundations (using semi-structured interviews with ten senior healthcare executives and qualitative analysis) which describe obstructions to progress. The study began with the premise that quality and affordable health care are dependent upon collaborative innovation. The growth of new leaders goes from skills to procedures and tools, and from training to development. Findings This paper makes “frugal innovation” recommendations which while not costly in a financial sense, do have practical and social implications relating to the Triple Aim. The research also revealed largely externally driven health care systems under duress suffering from leadership shortages. Research limitations/implications The study centred primarily on one Canadian community health care services’ organisation. Since healthcare provision is place-based (contextual), the findings may not be universally applicable, maybe not even to an adjacent community. Practical implications The paper dismisses outdated views of the synonymity of leadership and management, while encouraging clinicians to assume leadership roles. Originality/value This paper demonstrates how health care leadership can be developed and sustained.

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Purpose as a Powerful Resource in the Time of COVID-19

Journal of Humanistic Psychology ◽

10.1177/0022167820940464 ◽

2020 ◽

Vol 60 (5) ◽

pp. 682-689 ◽

Cited By ~ 1

Author(s):

Allison E. White

Keyword(s):

Health Care Systems ◽

School Settings ◽

The Past ◽

Sense Of Purpose ◽

Psychological Resource ◽

Care Systems ◽

Recommendations For Practice ◽

Work Family ◽

Development Literature

Coronavirus disease 2019 (COVID-19), a novel disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has claimed thousands of lives within the past few months; disrupted people’s participation in work, family, and school settings; and challenged economic and health care systems across the globe. In light of the countless challenges posed by COVID-19, a sense of purpose (i.e., a long-term life aim that guides behavior and contributes to the world beyond oneself) may be one important psychological resource for people of all ages to develop and/or recruit during this crisis. This article provides a brief overview of the purpose development literature, the argument that a growing or solidified sense of purpose can serve as an important internal resource during periods of adversity, and recommendations for practice during the COVID-19 pandemic.

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‘User pays’ and other approaches to the funding of long-term care for older people in Australia

Ageing and Society ◽

10.1017/s0144686x99007643 ◽

2000 ◽

Vol 20 (1) ◽

pp. 5-32 ◽

Cited By ~ 6

Author(s):

MICHAEL FINE ◽

JENNY CHALMERS

Keyword(s):

Older People ◽

Private Insurance ◽

Aged Care ◽

Future Generations ◽

Term Care ◽

Public And Private ◽

Alternative Funding ◽

Care Services ◽

The Cost

It has been argued that without some system in which future generations of users are able to pay for their care the cost of services for an increasingly large group of older people will be borne by a declining base of economically active younger people. Is the answer a user pays approach to the financing of aged care, as promoted by recent changes to aged care financing? This paper reviews this concept and its recent history in Australia. On the basis of a brief review of alternative funding systems, it also considers the potential of public and private insurance schemes to increase funding by potential service users and underwrite the long-term viability of funding for aged care services.

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