‘Working relationships’ across difference - a realist review of community engagement with malaria research

Background: Community engagement (CE) is increasingly accepted as a critical aspect of health research, because of its potential to make research more ethical, relevant and well implemented. While CE activities linked to health research have proliferated in Low and Middle Income Countries (LMICs), and are increasingly described in published literature, there is a lack of conceptual clarity around how engagement is understood to ‘work’, and the aims and purposes of engagement are varied and often not made explicit. Ultimately, the evidence base for engagement remains underdeveloped. Methods: To develop explanations for how and why CE with health research contributes to the pattern of outcomes observed in published literature, we conducted a realist review of CE with malaria research – a theory driven approach to evidence synthesis. Results: We found that community engagement relies on the development of provisional ‘working relationships’ across differences, primarily of wealth, power and culture. These relationships are rooted in interactions that are experienced as relatively responsive and respectful, and that bring tangible research related benefits. Contextual factors affecting development of working relationships include the facilitating influence of research organisation commitment to and resources for engagement, and constraining factors linked to the prevailing ‘dominant health research paradigm context’, such as: differences of wealth and power between research centres and local populations and health systems; histories of colonialism and vertical health interventions; and external funding and control of health research. Conclusions: The development of working relationships contributes to greater acceptance and participation in research by local stakeholders, who are particularly interested in research related access to health care and other benefits. At the same time, such relationships may involve an accommodation of some ethically problematic characteristics of the dominant health research paradigm, and thereby reproduce this paradigm rather than challenge it with a different logic of collaborative partnership.

Racial/ethnic disparities in exposure to COVID-19, susceptibility to COVID-19 and access to health care - findings from a U.S. national cohort

We examined the influence of racial/ethnic differences in socioeconomic position on COVID-19 seroconversion and hospitalization within a community-based prospective cohort enrolled in March 2020 and followed through October 2021 (N=6740). The ability to social distance as a measure of exposure to COVID-19, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity with non-white participants having more exposure risk and more difficulty with healthcare access than white participants. Participants with more (versus less) exposure had greater odds of seroconversion (aOR:1.64, 95% Confidence Interval [CI] 1.18-2.29). Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization (respective aOR:2.36; 1.90-2.96 and 2.31; 1.69-2.68). Race/ethnicity positively modified the association between susceptibility and hospitalization (aORnon-White:2.79, 2.06-3.78). Findings may explain the disproportionate burden of COVID-19 infections and complications among Hispanic and non-Hispanic Black persons. Primary and secondary prevention efforts should address disparities in exposure, COVID-19 vaccination, and treatment.

The role of tinnitus distress in the development of somatization symptoms among patients: implications for health care in Pakistan

Purpose Tinnitus patients are among the most vulnerable group to develop psychopathological symptoms over time if left unresolved. This study aims to investigate the role of tinnitus distress between tinnitus magnitude, cognitions and functional difficulties in the development of somatization symptoms among male and female patients experiencing ear-related problems due to lack of proper access to health care. Design/methodology/approach This study was based on a purposive sampling technique and sample consisted on 159 patients (97 male, 62 female) having tinnitus complaints, with age range 18–87 (M = 47.94, SD = 17.47) years, recruited from various clinics and hospitals of Islamabad, Pakistan, from December 2020 to July 2021. Findings The findings of this study showed that tinnitus distress is significant positively associated with tinnitus-related magnitude, negative cognitions, functional difficulties and somatization symptoms. Gender-related differences between male and female tinnitus patients revealed that females are more prone to depict higher levels of tinnitus distress, tinnitus magnitude, negative cognitions and somatization symptoms than male patients. Mediation analysis demonstrated that tinnitus distress serves as a mediator between tinnitus magnitude, cognitions, functional difficulties and somatization symptoms. Research limitations/implications Cross-sectional nature and self-reporting measures serve as a limitation of the study. An experimental study appears to be vital to ascertain the time-based relationship with tinnitus magnitude in the development of various psychopathological issues. The findings of this study contribute to the literature by highlighting the role of tinnitus distress in the origination of psychopathological symptoms like somatization and need of upgraded health-care systems in Pakistan. Originality/value This study has explored the mediating role of tinnitus distress between magnitude, cognitions, functional difficulties and somatization symptoms among Pakistani population, specifically mentioning the development of somatization symptoms among this population, which can contribute in the loss of earning and increased health expenses due to unawareness of proper health-care approach.

Satisfaction with Telepsychiatry during the COVID-19 pandemic: Patients’ and psychiatrists’ report from a University Hospital

Background: The COVID-19 pandemic has led to important changes in the approach to patients worldwide. Different agencies have proposed and implemented telemedicine-based care services in order to ensure access to health care for all people. Aim: The aim of this study was to determine the satisfaction of patients using the Telepsychiatry service offered by the Department of Psychiatry of the Hospital de Clínicas (National University of Asunción, Paraguay). Methods: A cross sectional and descriptive study has been conducted. Participants were recruited through a phone-based survey. Satisfaction with Telepsychiatry has been measured with an adapted version of a satisfaction survey in Teleneurology. As a complement, psychiatrists from the Hospital de Clínicas were also interviewed about their rate of satisfaction with Telepsychiatry. Results: A total of 530 patients were included, 51.3% of whom were women. The consultation satisfaction scale ranged between 2.15 and 4.30 with a mean score of 3.02 ± 0.32. Cronbach’s alpha for the scale was .897, indicating a good internal consistency. Patients’ satisfaction was higher for the perception of Telepsychiatry and lower for the doctor-patient relationship. Of the physicians, 87.5% were satisfied with the Telepsychiatry service. Conclusion: The satisfaction overall score indicates patients’ general satisfaction with the quality of care in Telepsychiatry, mainly regarding the perception of health care. and lower satisfaction with the doctor-patient relationship. Nine out of 10 psychiatrists felt satisfied with the Telepsychiatry service and considered that the degree of patient’s satisfaction was acceptable during the Telepsychiatry consultation.

Telemedicine in neonatal care-Saving lives with technology!

Madam, neonatal mortality in Pakistan i.e. death of babies within first twenty eight days of life is 49 per 1000 live births. Moreover, Pakistan contributes to 7% of global neonatal deaths. (1) Cause of mortality may be infection, intra-partum complications, prematurity or congenital birth defects but there is one thing common in all; majority of them occur in rural population due to lack of access to health care facilities. (2) With recent advances, role of tele-medicine has proved to be a milestone in field of medicine especially in underdeveloped and rural areas. According to World Health Organization (WHO), Telemedicine is defined as affordable use of Information and Communication Technology (ICT) for provision of health facilities and care. (3) A study done in Karachi in early 2020 by Ashfaq A et al showed average knowledge of telemedicine among clinicians and junior doctors, but we are still hopeful that since after the global pandemic of COVID-19, not just this knowledge has improved but also perceptions regarding telemedicine should have changed (4). In another study done in china by Makkar A. et al, they demonstrated the role of tele-medicine in not just tele-rounds of NICU but also successful e-examinations of Retinopathy of prematurity, tele-echocardiography, tele-NPR guidance to healthcare providers and family support. Moreover, home based care can be efficiently provided to preterm low birth weight babies including establishment of enteral feeding. (5) With a global shortage of physicians worldwide, lack of neonatologists is a major reason of neonatal referrals from rural areas and tele-medicine can give promising results in this regard. It can not only prevent unnecessary ambulation of tiny patients but also improve survival and quality care. Though under umbrella of private NGOs, tele-medicine is being started for satellite centers in few regions of country but obviously it doesn’t cover majority of population. It is high time to realize importance of Tele-medicine in periphery care setups. Though provision of equipment, installments of high quality ICT and infrastructure might seem a barrier in establishment of Tele-medicine but it can bring revolutionary improvement in neonatal care. It cannot just help reducing over burdening to tertiary care hospitals but also in avoiding hazards and cost of patient transfer.

Isolation in COVID, and COVID in Isolation—Exacerbated Shortfalls in Provision for Women's Health and Well-Being Among Marginalized Urban Communities in India

This paper describes the lived experiences of health seeking, health care recourse, and well-being of women waste pickers, a highly marginalized sub-population in urban areas in India, highlighting the intersectionality of gender, socioeconomic and cultural contexts, and occupational hazards that they face, as studied by a research team engaged in participatory action research with waste workers in urban India. We note the impact of the superimposition of the COVID-19 pandemic, with the restrictions on movement and access to livelihoods, social support, and health care, and policies made and enforced in a fragmented manner, on the already deprived conditions of the waste pickers. We reflect on the women waste pickers' practices of health seeking, their access to health care, the provisions made for them and made use of by them, and the support they could tap in protecting and restoring their health. A range of these experiences is illustrated through three case studies. Finally, recommendations are made for better provision for women's health and well-being, and improved preparedness for emergency situations.

Outlining the therapeutic itineraries of children with disabilities in the professional health care subsystem

ABSTRACT Objectives: to identify the outlining of therapeutic itineraries of families of children with disabilities in the professional health care subsystem. Methods: qualitative research carried out in two specialized services in the state of Ceará, with 41 family members interviewed using the life path technique and reports submitted to descending hierarchical classification and similitude analysis, with the help of the IRaMuTeQ software and the theoretical framework of health care systems. Results: the classes described the families’ itineraries in five paths, related to faith, support structures, medical behaviors, professionals, and health services. The professional subsystem stood out as deficient in outlining the therapeutic itinerary for access to health care for children with disabilities, without promoting integration between services in the Care Network. Final considerations: the families’ therapeutic itineraries showed homogeneous discourse with themes related to the care of professionals and spiritual aspects.

Antiracism in the Field of Neonatology: A Foundation and Concrete Approaches

Neonatal patients and families from historically marginalized and discriminated communities have long been documented to have differential access to health care, disparate health care, and as a result, inequitable health outcomes. Fundamental to these processes is an understanding of what race and ethnicity represent for patients and how different levels of racism act as social determinants of health. The NICU presents a unique opportunity to intervene with regard to the detrimental ways in which structural, institutional, interpersonal, and internalized racism affect the health of newborn infants. The aim of this article is to provide neonatal clinicians with a foundational understanding of race, racism, and antiracism within medicine, as well as concrete ways in which health care professionals in the field of neonatology can contribute to antiracism and health equity in their professional careers.

Access to healthcare during COVID-19 among ageing population in Latvia

Medical staff has worked tirelessly throughout the COVID-19 pandemic to test and treat coronavirus patients. However, the focus on the virus has caused huge disruption to healthcare services, resulting in delayed treatment for patients with other serious conditions. Additionally, the reasons for forgoing or abstaining healthcare could also relate to individual decisions. We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE), where the respondents aged 50 and older of the Wave 8, version 0, were asked to answer, among other, questions on delayed, postponed or denied healthcare services during the first wave of COVID-19 pandemic in Latvia. For comparative reasons also Estonian and Lithuanian data were included in the study with 2 473 627 valid weighted cases in total. Due to the large sample size, in order to evaluate statistically significant result for Pearson’s chi-square test, strength of association (f) was provided. The results show that 12.7% of the respondents forwent and 14% postponed medical treatment in Latvia. Appointment was denied to 5.5% of the respondents. Generally, older people in Latvia had better access to health care services compared to the average in the Baltic countries. We found significant age and gender differences, but they varied depending on the type of treatment and reason for not receiving it. However, further studies are necessary to analyse how limited access to the healthcare for other reasons has affected health of the ageing population. Also, more knowledge is needed about how to maintain public health and wellbeing for the growing part of the ageing society.