The needs, challenges, and burden experienced by informal caregivers in Uganda: a scoping review

Background The impact of informal caregiving is increasingly recognised as an important but often particularly neglected area of research in low and middle income countries. It is important to understand not only the effect of care on patient outcomes, but also the impact of caring on caregivers’ health and wellbeing. Methods Guided by the Arksey and O’Malley (Res Methodol 8:19–32, 2005) framework, this scoping review sought to collate and chart existing research on the needs, burdens and challenges experienced by caregivers in Uganda. Results The results of this review indicate that research focusing on the needs of caregivers for individuals with communicable disease, particularly HIV, has been well developed in Uganda, however, there is a lack of research on caregiving related to non-communicable diseases. Research has been dominated by small qualitative studies that are informative for understanding roles, burdens and contextually-specific aspects of care, but there is a need for larger studies that develop and test interventions designed to support the needs of caregivers. Conclusions Recurrent themes identified within this review, such as challenges in providing physical support and accessing treatment services, financial costs of care, psychological and mental health impacts and the experience of stigma, should help to inform well targeted and contextually-appropriate future research and interventions.

Parental Perceptions of Autism Spectrum Disorder in Latinx and Black Sociocultural Contexts: A Systematic Review

Parents of children with autism spectrum disorder (ASD) face challenges in accessing diagnostic and treatment services; these challenges vary by race, ethnicity, and culture. This systematic review examines parental perceptions of ASD within Latinx and Black American communities. Findings indicate that interconnections with family and religious groups promoted positive coping and describe positive impacts of having a child with ASD. Relative to White families, community members reported reduced access to information and more inaccurate beliefs about ASD, higher levels of ASD-related stigma, and more negative experiences with healthcare providers, which serve to exacerbate healthcare disparities. Conclusions are limited by an underrepresentation of minority groups in research. We call for efforts to address the specific needs of racial and ethnic minorities.

Decoding Emotion in Drug Abusers: Evidence for Face and Body Emotion Recognition and for Disgust Emotion

Background: Different drugs damage the frontal cortices, particularly the prefrontal areas involved in both emotional and cognitive functions, with a consequence of decoding emotion deficits for people with substance abuse. The present study aims to explore the cognitive impairments in drug abusers through facial, body and disgust emotion recognition, expanding the investigation of emotions, processing, measuring accuracy and response velocity. Method: We enrolled 13 addicted to cocaine and 12 alcohol patients attending treatment services in Italy, comparing them with 33 matched controls. Facial emotion and body posture recognition tasks, a disgust rating task, and the Barrat Impulsivity Scale were included in the experimental assessment. Results: We found that emotional processes are differently influenced by cocaine and alcohol, suggesting that these substances impact diverse cerebral systems. Conclusion: The contribution made by the duration of consumption on emotional processing seems far less important than for cognitive processes. Drug abusers seem to be slower on elaboration of emotions and, in particular, of disgust emotion. Considering that the participants were not impaired in cognition, our data support the hypothesis that emotional impairments emerge independently from damage to cognitive functions.

Estimating the population-level effects of Ontario's overdose prevention sites and consumption and treatment services: interrupted time series analysis with synthetic controls

Background: Ontario recently implemented overdose prevention sites and consumption and treatment services (OPS/CTS) to stem the harms of the opioid epidemic. We tested whether operating any site improved local opioid-related health service use and mortality rates. Methods: We used monthly counts of all opioid-related emergency department (ED) visits, hospitalizations, and deaths between January 2014 and December 2020 for our outcomes. For each public health unit (PHU) that implemented any OPS/CTS, we created a synthetic control as a weighted combination of unexposed PHU. We estimated the population-level effects of operating any site using controlled interrupted time series with segmented regression and adjusted for time varying confounders (i.e. OPS/CTS capacity, naloxone kits distributed, and persons receiving opioid agonist treatment per 100,000 population). We repeated the analysis using a multiple baseline approach to estimate province-wide effects. Results: Between 2017 and 2020, nine out of 34 PHU implemented at least one OPS/CTS. ED visit (RR=0.96, 95%CI: 0.92-0.99) and hospitalization (RR=0.95, 95%CI: 0.92-0.98) trends declined faster among treated units. Improvements in local ED visit rate trends were observed for the majority of treated units. Hospitalization rates declined faster for London (RR=0.97, 95%CI: 0.95-0.99) and Niagara (RR=0.95, 95%CI: 0.92-0.98); while mortality rates declined faster for Hamilton (RR=0.93, 95%CI: 0.90-0.96), Niagara (RR=0.97, 95%CI: 0.94-0.99) and Guelph (RR=0.94, 95%CI: 0.88-1.00). Conclusion: Although OPS/CTS are not sufficient to stem the harms of the opioid overdose epidemic on their own, they play a critical role in local harm reduction strategies.

People in Recovery from Substance Use Disorders: What Motivates Them to Enter Addiction Treatment Agencies as Counselors?

This qualitative study aimed to understand the motivations of people recovering from substance use disorders (SUDs) to work in addiction treatment agencies as counselors. A purposive and snowball sampling technique was used to recruit 18 recovering counselors from Long Island, New York. Most of the participants self-identified as Caucasian, and a third identified as African American. All interviews were audio-recorded and transcribed verbatim. The results indicate that want to give back, perceived self-efficacy to work with SUD clients, and previous experiences with addiction treatment services motivated people in recovery from SUD to become counselors. The respondents also reported the role of intrinsic rewards, such as witnessing clients’ progress over time and the opportunity to sustain their recovery, which influenced their decision to continue working in the addiction treatment field. Understanding work motivations has significant implications for assessing the staffing needs and professional development of SUD treatment programs, including recruitment, retention, and the overall size and capacity of the addiction treatment workforce.

Human-centered design process and solutions to promote malaria testing and treatment seeking behavior in Guyana hinterlands

Background Malaria is a persistent public health challenge among miners and other hard-to-reach populations in Guyana’s hinterland, specifically in Regions 1, 7, 8, and 9. Despite an overall decrease in malaria prevalence throughout Guyana, it remains common among mining populations whose work conditions both contribute toward malaria transmission and make it difficult to seek timely, Ministry of Health (MoH) approved malaria testing and treatment services. In an effort to develop innovative approaches to address this public health challenge, an interdisciplinary team of public health professionals, designers, and mining organizations collaborated using a human-centered design (HCD) process facilitated by the USAID-funded Breakthrough ACTION Guyana project in partnership with the MoH. Methods This paper describes two phases: [1] Define and [2] Design & Test. In the Define phase, following a literature review, we conducted 108 qualitative interviews with miners, camp managers, trained malaria testers, health workers, and other key stakeholders to understand experiences and challenges when seeking malaria testing and treatment services. These interviews were synthesized into 11 insights on issues such as risk perception, malaria knowledge, preventive behaviors, traditional and self-treatment, adherence to the correct treatment, testing, and coordination and communication gaps. From these insights, during the Design & Test phase, we developed 33 “How might we…?” questions which led to 792 ideas, of which eight emergent concepts were prototyped and refined in the field with 145 miners, camp managers, and stakeholders. Results The five final prototypes included: “Little Mosquito, Big Problem” social behavior change campaign; rapid counseling cards; branded malaria testing and treatment services; innovations in treatment adherence; and a participants, content, and logistics approach. Conclusion When applying HCD to public health issues, there are both opportunities and challenges to reconcile gaps that may exist between the two disciplines. However, HCD provides additional tools and mindsets to generatively work with migrant and mobile mining communities to encourage malaria testing and treatment services.

Defining Appropriate Resources for Nursing Homes to Reduce Potentially Avoidable Transfers After a Fall

Falls are common in nursing home (NH) residents and are the predominant reason for an emergency department (ED) transfer. Falls are responsible for 25% - 87% of ED transfers, a proportion of which are potentially avoidable. INTERCARE – an implementation science study reducing unplanned hospitalizations (2018 – 2020) – involved experts to identify potentially avoidable fall-related transfers. Focus group and stakeholder survey enabled identification of resources to safely manage some falls in NHs. 25.9% of fall-related transfers were potentially avoidable based on using root-cause analysis and discharge reports. Avoidability was associated to ED visit, compared to hospitalizations. Appropriate resources identified by stakeholders included timely access to outpatient services for diagnostic imaging (e.g., X-Ray) and clinical skills’ training in suturing and wound care for registered or specialist nurses. Although NHs are striving for a home-like environment, better access to basic diagnostic and treatment services within NHs should be possible.

Acceptability and feasibility of malaria prophylaxis for forest goers: findings from a qualitative study in Cambodia

Background In the Greater Mekong Subregion, adults are at highest risk for malaria, particularly those who visit forests. The absence of effective vector control strategies and limited periods of exposure during forest visits suggest that chemoprophylaxis could be an appropriate strategy to protect forest goers against malaria. Methods Alongside a clinical trial of anti-malarial chemoprophylaxis in northern Cambodia, qualitative research was conducted, including in-depth interviews and observation, to explore the acceptability of malaria prophylaxis for forest goers, the implementation opportunities, and challenges of this strategy. Results Prophylaxis with artemether–lumefantrine for forest goers was found to be acceptable under trial conditions. Three factors played a major role: the community’s awareness and perception of the effectiveness of prophylaxis, their trust in the provider, and malaria as a local health concern. The findings highlight how uptake and adherence to prophylaxis are influenced by the perceived balance between benefits and burden of anti-malarials which are modulated by the seasonality of forest visits and its influence on malaria risk. Conclusions The implementation of anti-malarial prophylaxis needs to consider how the preventive medication can be incorporated into existing vector-control measures, malaria testing and treatment services. The next step in the roll out of anti-malarial prophylaxis for forest visitors will require support from local health workers.

Analysis of Influencing Factors on Hospitalization Expenses of Patients with Breast Malignant Tumor Undergoing Surgery: Based on the Neural Network and Support Vector Machine

Objective. Analyze the influencing factors of hospitalization expenses of breast cancer patients in a tertiary hospital in Chengdu and provide a basis and suggestion for controlling the unreasonable increase of medical expenses. Methods. The first pages of all inpatient medical records of patients with breast malignant tumor from 2017 to 2020 were extracted, and the descriptive analysis, single-factor analysis, and multifactor analysis were conducted by using the statistical method and data mining method to explore the influencing factors of hospitalization expenses. Results. In 2017–2020, the average hospitalization cost and the average surgical treatment cost increased year by year, and the number of operations, actual hospitalization days, and CCI were the important influencing factors. Conclusion. It is suggested to strengthen the supervision of medical rationality and eliminate the waste of medical resources; and we should improve the efficiency of diagnosis and treatment services, so as to shorten the actual length of hospitalization; at the same time, the combination of DRG grouping and fine management can be used to control the hospitalization expenses.

Behavioral Healthcare Providers’ Experiences Related to use of Telehealth as a Result of the COVID-19 Pandemic: An Exploratory Study

Background: Due to the COVID-19 pandemic, healthcare providers were forced to shift many services quickly from in-person to virtual, including substance use disorder (SUD) and mental health (MH) treatment services. This led to a sharp increase in use of telehealth services, with health systems seeing patients virtually at hundreds of times the rate as before the onset of the COVID-19 pandemic.By analyzing qualitative data about SUD and MH care providers’ experiences using telehealth, this study aims to elucidate emergent themes related to telehealth use by the front-line behavioral health workforce.Methods: This study uses qualitative data from large-scale web surveys distributed to SUD and MH providers between May and August 2020. At the end of these surveys, the following question was posed in free-response form: “Is there anything else you would like to say about use of telehealth during or after the COVID-19 pandemic?” The 391 responses to this question were analyzed for emergent themes using a conventional approach to content analysis.Results: Three major themes emerged in the data: COVID-specific experiences with telehealth, general experiences with telehealth, and recommendations to continue telehealth delivery. Convenience, access to new populations, and lack of commute were frequently cited advantages, while perceived ineffectiveness of and limited access to technology were frequently cited disadvantages. Also commonly mentioned was the relaxation of reimbursement regulations. Providers supported continuation of relaxed regulations, increased institutional support, and using a combination of telehealth and in-person care in their practices. Conclusions: This study advanced our knowledge of how the behavioral health workforce experiences telehealth delivery. Further longitudinal research comparing treatment outcomes of those receiving in-person and virtual services will be necessary to undergird organizations’ financial support, and perhaps also legislative support, of virtual SUD and MH services.