Bounded Solidarity as an Asset for Public Health Care Intervention

The relationship between social capital and public health has been extensively analyzed. However, not much has been written about the formation of social capital among citizens and public health workers in times of a pandemic. Our aim is to analyze social capital development through the prism of bounded solidarity and seek its manifestations toward public health workers. A qualitative self-administered survey was used to analyze what actions, practices, attitudes, and reasons inspired citizens to behave as they did with respect to public health workers during the first weeks of lockdown under the COVID-19 pandemic. Respondents, mostly from European countries, reveal that citizens aimed to prevent the collapse of the public health system through reinforcing trust toward institutions, legitimizing health care personnel expertise, practicing reciprocity and altruism, giving recognition to public health workers, and providing them with means. Finally, recommendations for public health communication on risks and crises are discussed.

Elderly´s Malnutrition, Processes/health Outcomes in Primary Health Care: A Scoping Review

Objectives - The aim of this study, as the first review directed at Primary Health Care, is identifying screening/intervention tools/health outcomes that validate malnutrition in the elderly. Methods - Following PRISMA, searches were conducted in 4 electronic databases on observational, qualitative, quantitative, or mixed studies, written in Portuguese, Spanish or English language, with participants aged 65 years or older. Results - 483 studies were identified, 16 were considered eligible. The Mini Nutritional Assessment showed the highest criteria of choice, however, health systems do not demonstrate standardized practices in the screening´s use. Studies are more oriented towards the relationship´s analysis of mortality/morbidity and malnutrition than its effects on the person´s quality of life. Discussion - Malnutrition is one of the modifiable factors and contributes to the frail elderly condition, with serious effects, especially when related to other comorbidities. Yet, several authors argue that Primary Health Care intervention can improve health outcomes.

Dealing With Pluralism: Managerial Work of CEOs in Italian Public Healthcare Organizations

Background: Healthcare organizations are extremely complex, and the work of their CEOs is particularly demanding, especially in the public sector. However, we know little about how healthcare executives’ managerial work unfolds. Drawing from scholarship on pluralistic organizations and managerial work, we answer the questions: what is the content of managerial work of executives in public healthcare? How do CEOs deal with pressures from internal and external stakeholders while maintaining a strategic agenda?Methods: We adopted a mixed method with a survey to measure CEO behaviors, coding CEOs time for four weeks; a questionnaire to understand the strategic dimensions of interactions; interviews of senior CEOs.Results: CEOs in Italian public healthcare devote most of their time to interactions, by and large responding to pressures by internal stakeholders. Although half of this time is perceived as occupied in answering operational requests, this is necessary to nurture relations, create networks and develop alliances and consensus, which are functional in achieving CEOs’ strategic agenda.Conclusions: CEOs in public healthcare must deal with enormous contextual pressures and cannot manage the complexity but are called to manage within the complexity, fostering involvement in decision making, building networks, and establishing alliances. Amidst ambiguity and fragmentation, executives need to find solutions to perform their managerial work without being entrapped by stakeholders’ pressures, thanks to effective stakeholder management as well as delegation.Trial registration: The article does not report the results of a health care intervention on human participants, and material used in the research did not need ethical approval according to Italian law.

Practical and emotional problems reported by the general public during the COVID-19 pandemic when using a self-guided digital problem-solving intervention: A content analysis (Preprint)

BACKGROUND In order to better direct assessments and interventions towards the general population during the ongoing coronavirus disease 2019 (COVID-19) pandemic and future crises with societal restrictions, data on the types of practical and emotional problems people are suffering from are needed. OBJECTIVE The aim of this study was to examine what types of practical and emotional problems the general population is suffering from during the COVID-19 pandemic, and to construct an empirically derived inventory based on the findings. METHODS A total of 396 participants from the general public, with practical and/or emotional problems, accessed a self-guided digital problem-solving intervention for a period of one week to report and solve problems they experienced. Prior to accessing the intervention, participants completed a short self-assessment regarding symptoms of depression and anxiety. Content analysis was used to account for the types of problems participants reported. A set of items for an inventory was later proposed based on the problem categories derived from the analysis. RESULTS A majority of participants had either clinically relevant symptoms of depression or anxiety. The problems reported were categorized as 13 distinct types of problems. The most common problem was difficulties managing daily activities. Based on the categories, a 13-items inventory was proposed. CONCLUSIONS The 13 types of problems, and the proposed inventory, could be valuable when composing assessments and interventions for the general population during the ongoing pandemic or similar crises with societal restrictions. The most common problem was of practical nature, indicating the importance of including examples of such problems within assessments and interventions. CLINICALTRIAL This article does not report results of a health care intervention, but was nevertheless retrospectively registered on ClinicalTrials.gov (ID: NCT04677270).

A Turkish Plague Tale: Dying Healthcare Workers in Pandemics

Background: The aim of the present study is to analyze the data obtained in the pandemics to highlight the picture that emerged in the struggle against the disease in Turkey, with special emphasis on the deaths of healthcare workers (HCW). Methods: In this report, the age, gender, province and institution of employment, distribution of death by months, occupation, chronic disease status, and death rates by occupation of 403 active HCW who died due to COVID-19 disease from the beginning of the epidemic until May 31, 2021 were evaluated. Results: A majority (n=351, 87.1%) of the HCW who lost their lives due to COVID-19 are male. More than one third (36.0%) of all COVID-19 deaths in HCW are physicians; 13.2% (n=53) was pharmacists and 6.0% (n=24) was nurses and midwives. Working in private sector is overrepresented in deaths. Death due to COVID-19 is 8.32 per 10,000 among physicians; 13.78 in male physicians; while only 0.56 in female physicians. Mortality among HCW has slowed down since the vaccine was introduced.Conclusions: Deaths that have occurred or may occur due to COVID-19 are mostly preventable deaths. Deceased HCW are significantly younger than all COVID-19 deaths, which suggests that HCW have not been protected necessarily. Likewise, the number of deaths among blue-collar workers in healthcare is more frequent in those younger than 50 years old is an indication of the class nature of the pandemic. Trial registration: The article has not been pre-registered because it does not include reports of a health care intervention on human participants.

Challenges in co-designing an intervention to increase mobility in older patients: a qualitative study

PurposeThe aim of this study is to explore and discuss key challenges associated with having stakeholders take part in co-designing a health care intervention to increase mobility in older medical patients admitted to two medical departments at two hospitals in Denmark.Design/methodology/approachThe study used a qualitative design to investigate the challenges of co-designing an intervention in five workshops involving health professionals, patients and relatives. “Challenges” are understood as “situations of being faced with something that needs great mental or physical effort in order to be done successfully and therefore tests a person's ability” (Cambridge Dictionary). Thematic content analysis was conducted with a background in the analytical question: “What key challenges arise in the material in relation to the co-design process?”.FindingsTwo key challenges were identified: engagement and facilitation. These consisted of five sub-themes: recruiting patients and relatives, involving physicians, adjusting to a new researcher role, utilizing contextual knowledge and handling ethical dilemmas.Research limitations/implicationsThe population of patients and relatives participating in the workshops was small, which likely affected the co-design process.Practical implicationsResearchers who want to use co-design must be prepared for the extra time required and the need for skills concerning engagement, communication, facilitation, negotiation and resolution of conflict. Time is also required for ethical discussions and considerations concerning different types of knowledge creation.Originality/valueEngaging stakeholders in co-design processes is increasingly encouraged. This study documents the key challenges in such processes and reports practical implications.

The Food, Feelings, and Family Study: comparison of the efficacy of traditional methods, social media, and broadcast email to recruit pregnant women to an observational, longitudinal nutrition study

Background It is well known that recruitment is a challenging aspect of any study involving human subjects. This challenge is exacerbated when the population sought is reticent to participate in research as is the case with pregnant women and individuals with depression. This paper compares recruitment methods used for the Food, Feelings, and Family Study, an observational, longitudinal pilot study concerning how diet and bisphenol A exposure affect maternal mood and cognitive function during and after pregnancy. Methods Pregnant women were recruited to this study over a period of 15 months using traditional methods, social media including paid and unpaid posts, and emails broadcast to the university community. Contingency analysis using the Pearson’s Chi-square test was used to determine if recruitment method was associated with likelihood of participation. T-tests were used to analyze Facebook advertisement success. ANOVAs and Fisher exact tests were used to determine if recruitment method was related to continuous and categorical demographics, respectively. Results Social media resulted in the largest number of recruits, followed by traditional methods and broadcast email. Women recruited through social media were less likely to participate. In contrast, use of broadcast email resulted in a smaller pool of recruits but these recruits were more likely to be eligible for and complete the study. Most women recruited via social media were the result of unpaid posts to the study’s Facebook page. Paid posts lasting at least 4 days were the most successful. Recruitment method was not associated with participant demographics. Conclusions Social media has the potential to recruit a large pool of potential subjects; however, when studies require a large time investment such as the case here, women recruited through social media are less likely to participate and complete the study than women recruited through other means. Trial registration N/A. This study does not describe a health care intervention.

“It’s all about delivery”: researchers and health professionals’ views on the moral challenges of accessing neurobiological information in the context of psychosis

Background The convergence of neuroscience, genomics, and data science holds promise to unveil the neurobiology of psychosis and to produce new ways of preventing, diagnosing, and treating psychotic illness. Yet, moral challenges arise in neurobiological research and in the clinical translation of research findings. This article investigates the views of relevant actors in mental health on the moral challenges of accessing neurobiological information in the context of psychosis. Methods Semi-structured individual interviews with two groups: researchers employed in the National Health Service (NHS) or a university in England (n = 14), and mental health professionals employed in NHS mental health services (n = 14). This article compares results in the two groups (total n = 28). Results This article presents findings around three conceptual areas: (1) research ethics as mostly unproblematic, (2) psychosis, neurobiological information, and mental health care, and (3) identity, relationships, and the future. These areas are drawn from the themes and topics that emerged in the interviews across the two groups of participants. Researchers and health professionals provided similar accounts of the moral challenges of accessing—which includes acquisition, communication, and use of—neurobiological information in the context of psychosis. Acquiring neurobiological information was perceived as mostly unproblematic, provided ethical safeguards are put in place. Conversely, participants argued that substantive moral challenges arise from how neurobiological information is delivered—that is, communicated and used—in research and in clinical care. Neurobiological information was seen as a powerful tool in the process through which individuals define their identity and establish personal and clinical goals. The pervasiveness of this narrative tool may influence researchers and health professionals’ perception of ethical principles and moral obligations. Conclusions This study suggests that the moral challenges that arise from accessing neurobiological information in the context of psychosis go beyond traditional research and clinical ethics concerns. Reflecting on how accessing neurobiological information can influence individual self-narratives will be vital to ensure the ethical translation of neuroscience and genomics into mental health. Trial registration The study did not involve a health care intervention on human participants. It was retrospectively registered on 11 July 2018, registration number: researchregistry4255.