Search

This paper aims to address the comorbidity effect of type 2 diabetes (T2D) and poor mental health and wellbeing. According to the International Diabetes Federation, 463 million people worldwide (adults 20-79 years old) were living with T2D in 2019, this number is expected to increase to 700 million by 2045 (Inmaculada et al, 2020). 1 in 10 people over the age of 40 have a diagnosis of diabetes (Diabetes UK, 2019). The Scottish Public Health Observatory has estimated that almost half of T2D can be attributed to obesity (Scottish Gov, 2018). The World Health Organization considers depression to be one of the leading causes of health deterioration and progression towards disability. This condition has been associated with a higher risk of diabetes complications and increased health care utilization among patients with T2D. The prevalence rate of depression is more than twice as high in people with T2D (19.1%, range 6.5-33% vs. 10.7%, range 3.8-19.4%) compared to those without (Tapash et al, 2012). T2D patients are also at risk of developing eating disorders (Raevuori et al., 2014). T2D can be improved by healthy lifestyle choices, such as maintaining a balanced diet, daily exercise such as walking, and maintaining a healthy BMI (NHS, 2017). To develop a healthy self-management pattern, this paper advocates for positive mental health in order to improve general well-being to live life to the fullest. [ABSTRACT FROM AUTHOR]

Introduction Caregiving work in 'residential care homes for the elderly' (RCHEs) has long been devalued as 'dirty work', which contributes to RCHE's acute shortages of health care staff in Hong Kong. This study aims to unearth the voice of the RCHEs workers by delineating their insider perspectives of RCHE work. Method Adopting the Photovoice method, a participatory methodology, 30 RCHEs care workers (i.e. Registered Nurses, Enrolled Nurses, Health Workers, and Personal Care Workers) were invited to take photos that showcase their perspectives of doing aged care work. Two in-depth interviews were conducted with each research participant before and after the photo-taking procedure. Thematic analysis is then conducted to analyse the visual and verbal data. Results Findings show that RCHEs care workers perceive and revitalize the nature and meaning of their work in four ways: conducting 'dirty tasks' to help the elderly; valuing and engaging in long-term relationships; learning in work; and cultural meaning of working with the elderly. Contrary to public devaluation, RCHE care workers normalize the delivery of 'dirty tasks' (i.e. handling human excreta and wounds) as being helpful to both the elderly and the family members. Besides the routine caring tasks on paper, care workers highlight that they spend a lot of unrecognized labor to build rapport and provide emotional support to the elderly and their family members in their work. They also report that learning and self-development are an important part of residential care work, both in terms of professional knowledge and personal growth. Taking care of the elderly also conveys positive cultural meanings in Chinese society. Conclusion Policy, professional and educational initiatives of geriatric care primarily emphasize the delivery of clinical tasks (caring for), while undermining the emotional and relational aspects of aged care work. The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China. (UGC/FDS16/M12/20). [ABSTRACT FROM AUTHOR]

Purpose Dementia is a progressive disease that affects elderly people, and may develop loss of functional capacity, loss of physical, and cognitive abilities and neuropsychiatric symptoms. The treatment with non- pharmacological interventions is being increasingly recognized and studied globally, given its lower risks when compared to drug treatment. The Fleming - Bennett Design Principles for People with Dementia describe items for the purpose of designing environments to support people with dementia and their families in reaching their full potential as human beings. Building structured environments can positively impact significant activities, functionality, safety, socialization and quality of life for those who reside there. This paper intend to describe the home environments of people with dementia and the perception of family members regarding the environmental design principles proposed by Fleming - Bennett. Method It was a descriptive, exploratory study, qualitative, with a convenience sample. Eight family's members of elderly people with dementia at different stages of staging were interviewed. The data collection included two structured online interviews, a sociodemographic questionnaire and a characterization of the functional capacity of the family and the environment based on Fleming - Bennett principles. The content analysis method was used as a strategy to identify empirical categories from the interview records. Results and Discussion It was observed as thematic categories: Security; Stimulation; Socialization; Familiarity and Difficulties in the care of the elderly with dementia. It is observed that the safety aspects are the most noticed in the adaptations of the environment. As for the environment to provide stimulation to the resident, they mention items available in the house such as furniture and objects of memory and affection such as photos, paintings, trophies, etc. They refer to the difficulty in the engagement of the elderly with the environment, as well as the management of visits and external exits of the house for severe stages of dementia. Most of the family members carry out environmental changes according to their perceptions, without the help of specialized professionals. Many items of the Fleming - Bennett principles are not covered in the elderly-s home, however they recognize that they could make the environment more functional, stimulating, and comfortable, once they have come into contact with this knowledge. Conclusion: Environmental changes need to be designed with a focus on the needs of people living with dementia and their families. The Fleming - Bennett principles have great importance as a guideline for public policies aimed at supporting the lives of people and their families living in this condition. Guiding aging in the right place for people living with dementia should be concern of all public policy which involves various sectors of society such as health, housing, social assistance and protection, services, and others. [ABSTRACT FROM AUTHOR]

Introduction: The care needed at end of life can go beyond what services can offer. This is where volunteers can make a difference, however the nature of their support can vary. Dodd et al. [1] recognised two types of input: 'being there' and 'doing for'. Similarly, Burbeck et al. [2] examined the volunteer role and found three themes; the distinctness, characteristics and experience of the role. Here, a volunteer can be mediating between patients and staff, sometimes acting as a surrogate family member. Such complexity requires further study and more detailed information about the impact on care recipients, and the volunteers themselves, would greatly assist the training and development of volunteers as well as decisions on how to maximise the use of volunteers to achieve the most benefit. Compassionate Isle of Man (IOM) has been developing the role of volunteers as Palliative Care Companions in the community. This evaluation aims to capture the impact and experience of volunteers and care recipients and examine the explicit and implicit needs for palliative care that they address. This paper will report on the pilot of the methods and initial findings. Aims: To use capability measures, qualitative and other data to identify the implicit and explicit needs for volunteer support, the short-term impact(s) on care recipients and volunteers and the implications for the training of volunteers. Methods: A prospective study will enrol care recipients and their carers at the outset of Compassionate IOM support. Baseline data will include stated needs as well as the ICEpop CAPability (ICECAP) measures [3] and interviews. Data collection will be repeated at 6 and 12 weeks and will include specially designed questionnaires and interviews to elicit perceptions of impact, satisfaction and details of the support experience. This information will be set within a cost-benefit framework to quantify the extent to which declared and undeclared needs are met, at what cost and with what benefits to care recipients and volunteers. The initial pilot study will test the methods and include at least 10 care recipients, their main carers and the related volunteers. Conclusion and implications: This pilot study will form the basis for a longer-term study which will provide essential information on the potential scope of volunteer support and their place in the overall service delivery of palliative care in the community. [ABSTRACT FROM AUTHOR]

Introduction Increasing demand for interprofessional collaboration in health care settings has increased focus on the influence of conditions, but we know little about the magnitude of interactions between conditions. Conditions are determinant factors that can affect interprofessional collaboration. This paper aims to examine the relationships of intervention conditions and context conditions at the professional and organizational levels and analyze how they influence the staff's perceived success of interprofessional collaboration. Intervention conditions relate directly to integrated care models (e.g. strategy, clarity of roles and tasks). Context conditions do not directly relate to interventions, but they surround interprofessional collaboration (e.g. management support, trust amongst staff). Theory/Methods This study develops an analytical framework drawing on the RMIC-framework to operationalize intervention conditions and the iCoach-framework to operationalize context conditions. The study was conducted as a multilevel cross-sectional survey in March of 2019 in the second largest municipality in Denmark (Aarhus). The study population was all frontline-staff members and managers in nursing homes, home care units and health care units. The final sample consisted of 498 staff members and 27 managers. Confirmatory path analysis was used to analyze the data. Results The results indicate that context conditions greatly influence intervention conditions at the professional and organizational levels and that the professional and organizational levels moderately co-variate. Professional level context conditions have the biggest influence on staff's perceived success, partly because some of its influence is confounded by intervention conditions. Discussions Our study stress the importance of opening the 'black box' surrounding context as a condition type. Based on our results we would expect that: conditions in general are a good predictor of the success of collaborations; context conditions are the most influential condition type with an indirect effect confounded by intervention conditions; conditions on different analytical levels co-variate. However, this raises questions about variation across country, sector, and case. For example, the most important individual context conditions may vary depending on setting. Nevertheless, the most important context conditions in the present study are well known in much of the literature, which might indicate low variance across settings. Conclusions Practice and research in health service delivery need to move from a broad understanding of context as unchangeable and inconsequential, to an understanding of context as an active condition type, which requires closer attention. Lessons learned Political and administrative decision-makers can purposely mould context conditions. In the present study, the four context conditions at the professional level are far from unchangeable. This means that leaders should analyze and work with context conditions as part of designing and implementing integrated care initiatives. Limitations Firstly, although the analytical framework is drawing on validated frameworks, it is not a thoroughly validated measurement tool itself. Secondly, the outcome measure is a proxy-variable. Lastly, there can be hypothesized additional paths and variables in the final path analysis model (e.g. patient and system level conditions). Future research Future research should open the 'black box' of context, by further exploring how different types of conditions on different analytical levels play out in different settings. [ABSTRACT FROM AUTHOR]

Background: The health harms caused by sex-normalising and unnecessary irreversible medical interventions on intersex infants and children can include chronic pain, a need for repeat surgeries, damage to sexuality, serious mental health problems, and sterility. However, access to appropriate healthcare is needed - occasionally for lifesaving treatments in minors, but more often for reparative treatment or condition management in those able to give consent. A social model of intersex health, drawing on disability theory, is useful but insufficient to address intersex issues. Agency and bodily autonomy are key for this population, and this paper aims to develop an agency based model. Methods: Qualitative semi-structured interviews were conducted with 40 stakeholders in Italy, Switzerland and the UK, and participant observation and action research was carried out with the intersex activist organisation Zwischengeschlecht. The research was funded by the European Commission (grant number 703352). Results: At present there are still serious healthcare deficits which are underpinned by social norms that include rigid ideas that there are only discrete categories of male and female, and entrenched medical practices that continue to violate intersex minor’s bodily integrity, whilst overlooking healthcare needs that intersex people may have. Key impediments to intersex agency include body normativity and sex and gender binarism. Conclusions: Agency-based approaches to the health of intersex people and those with differences of sex development (DSD) focus on bodily autonomy and the cessation of normalising medical interventions until an under-age person can exercise fully informed choice regarding treatment. These approaches can be useful in incorporating the social model’s critique of the pathologisation of bodily diversities, whilst supporting the provision of effective healthcare where needed. [ABSTRACT FROM AUTHOR]

Background: Asylum seekers and refugees risk poorer public health information and difficulties to follow measures during the COVID-19 pandemic because of language, cultural, administrative barriers and social insecurity. We investigate their attitudes and knowledge about COVID-19 measures. Methods: A cross-sectional survey conducted between August and October 2020 in the canton of Vaud, Switzerland. The 24 questions covered health literacy, perception of the pandemic, understanding of health measures and adherence to conspiracy theories. The questionnaire was translated into the ten most common languages. It was distributed online through social networks of charitable and public organisations and in paper in asylum centres. Associations between participants responses and their characteristics were studied using multivariable logistic regressions. Results: The 242 respondents had a mean age of 33 years, 63% were men and 42% had low health literacy. They were 16% asylum seekers, 45% temporarily admitted persons, 12% refugees and 26% rejected asylum seekers. All languages were used. Self-reported adherence to recommendations was 82%. Respectively, 39% and 31% of participants reported sleep disorders or fear of dying. Adjusted for age, gender, health literacy and French language skills, rejected asylum seekers were less worried about the pandemic (aOR 0.37, p = 0.007) and more sensitive to conspiracy theories (aOR 3.47, p = 0.006) than other respondents. They also reported lower adherence to recommendations (aOR 0.45, p = 0.034). Conclusions: We contribute new knowledge about a varied group of vulnerable persons under precarious conditions during the COVID-19 pandemic. The network based multi-language survey combining online and center based distribution was useful but also tedious. Our results highlight the low health literacy of asylum seekers and refugees and their deep concerns about the pandemic. Public health messages should be adapted to rejected asylum seekers. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment increases the difficulty of rehabilitation. Therapeutic approach involving cognitive rehabilitation using an integrated treatment method is essential. Clinical use of Computer Assisted Cognitive rehabilitation (CACR) has increased in the treatment of neurological patients since its level of difficulty can be adjusted to suit an individual's cognitive level, which reduces treatment time and costs. Objectives: The objective of this study was to identify the effect of mobile-based programs in improving cognitive skills among patients with stroke. Study Design: This was a quasi-experimental study design. Methods: Twenty people diagnosed with stroke (Stage III or IV from Brunnstrom stages) were selected based on a convenient sampling method and were separated into two groups. The experimental group (n = 10) received the mobile-based programs for 36 sessions with 45 min each, whereas the control group received conventional therapy for the same time period. MMSE (mini--mental status examination) and Lawton IADL were used as outcome measures. Results: The study resulted that the CACR was effective among people with stroke and thus it has shown considerable changes in cognitive and self-care skills. Furthermore, it resulted that the CACR had a significant impact on cognition and self-care skills when compared to conventional therapy (P < 0.005). Conclusion: This study concluded that CACR had an impact on cognitive abilities and self-care skills. Hence, CACR can be used as a new therapy modality in treating people with stroke. [ABSTRACT FROM AUTHOR]

Purpose Public facilities, including schools and restaurants have been restricted under coercive measures during COVID-19. People were forced to stay at home or residential facilities and the opportunities of face-to-face gathering were minimal. Adults and young people have switched to the online medium for their work and study. However, many older adults could not take advantage of the Internet or online resources because they lacked the skill and resources, leading to loneliness and social isolation. There was an association between depression and stay-home measures, which also impacted the physical functioning of older adults (Kwan et al., 2020). On the other hand, universities hosted service-learning education to help those in need. In addition, students can apply their knowledge learnt from the university onto the society or community, in which the gerontechnology course is one of the good examples. Recently, gerontechnology has been widely embraced by caregivers to promote the well-being of elderly, including the use of smartphone apps, fall detector, anti-wandering sensor and companion robot (Cheung et al, 2010, 2021, 2020). This study aimed to develop a social robot to promote intergenerational interaction that alleviates the loneliness among elderly. Method As shown in Figure 1, a social robot was developed using the Raspberry Pi 4 single board computer (Raspberry Pi Foundation, Cambridge UK), a 7-inch LCD display, a 16-channel 12-bit PWM/Servo Driver - I2C interface PCA9685 module (AdaFruit Industries, NYC, USA), and 6 compact servo motors. The LCD was used as the face of the robot. An in-house design robot housing and internal structure were fabricated using 3D printed acrylonitrile butadiene styrene (ABS). The customized software was coded using Python running on Raspbian OS. Three games were designed, including guessing traditional Chinese food, mathematics multiple operation, and daily news quiz. The setup also includes robot cover, backdrop, pair of Bluetooth speakers, and projector (Figure 1). Question, narrative, and game flow were generated and controlled by the program with native voice support. The question and photo were shown on the protection screen during the game. The "emotion response" of the robot appeared by means of the facial expression on LCD display and arms motion. The robot voice was controlled by the program and an operator to accommodate different service recipients. The students developed and operated the robot to serve the older adults in a community center in the service learning course (gerontechnology) during COVID-19 in compliance with the pandemic control measures. Results and Discussion The community center arranged 2 days for service and robotic team with 6 students interacted with approximate 60 elderlies per visit. The older adults and students demonstrated good interactions modulated by the robot and game. The center staff reported that the older adults had an improved mood and psychosocial change after the event. Future study may consider enhance the voice recognition function, motor feedback system and question bank management system. [ABSTRACT FROM AUTHOR]

Purpose One of the representative social activities that affects successful aging is volunteer work. The purpose of this study is to examine the effects of volunteer activity characteristics and social support on successful aging and the mediating effects of volunteer satisfaction and gender differences, along with the relationships among these variables. The characteristics of volunteer activities consists of the number of monthly hours and the level of motivation to participate. Existing studies (Kim & Choi, 2012; Lee, 2009) found that the frequency of volunteering and the motivation to participate influenced the volunteer satisfaction of older adults. Hwang (2010) revealed that volunteer satisfaction was positively associated with successful aging. Social support has also been found to be positively related to both volunteer satisfaction (Moon, 2015) and successful aging (Gyasi & Phillips, 2020). Based on these findings, volunteer satisfaction is expected to play a mediating role in the relationship between volunteering characteristics and successful aging. Meanwhile, elderly males and females with different life courses may have a gap in terms of volunteering and social support. These gender differences can have a significant effect on successful aging. Furthermore, volunteer satisfaction can differ depending on social network size and the degree of social support, which in turn directly or indirectly affect successful aging. Another purpose of this study is to help make policies and practical recommendations to improve volunteer satisfaction through technology (smart phones, Internet, ICT) for both males and females. Method A self-administered survey was given to elderly people aged 60 and older living in Gwangju and Jeolla Province, South Korea. 542 participants that are currently volunteering or regularly participated in volunteer work for more than 6 months were included in this study. The SPSS 25.0 program for data analysis, descriptive statistics, correlation, and hierarchal linear regression was used to analyze the effects on the main variables of successful aging. Apart from regression analysis, structural equation modelling (SEM) was used to test the mediating effects of volunteer satisfaction and gender differences on the mediating model. Results and Discussion The results obtained in this study showed that the mean score for successful aging was 3.87 (range: 1~5), and that the successful aging score of males (3.92) was significantly higher than that of females (3.82). Males (3.54, range 1~5) had a significantly higher volunteer motivation than females (3.40). The mean scores for the size of the social network (3.11, range 1~5), social support (3.66, range 1~5), volunteer satisfaction (4.06, range 1~5) showed no gender differences. In this study, purposive motivation, the size of friend/neighbor networks and family support can be used to predict the successful aging of males and females. When examining mediating effects, volunteer satisfaction was found to have a full mediation effect on the relationship between the motivation to participate in volunteering and successful aging for both males and females. On the other hand, volunteer satisfaction was found to have a partial mediation effect on the relationship between social support from family and friends/neighbors and successful aging for both males and females. In terms of gender differences, volunteer satisfaction only had a partial mediation effect on the male group when the size of the social network affected successful aging. Meanwhile, the size of family/relative networks had a positive effect on the successful aging of women. Based on the research results, it is necessary to provide online volunteer programs that incorporates both education and counseling. Since there has been an increase in the number of chatbot services used in caring for the elderly, a method to expand the volunteering areas for managing chatbot services is also needed. Mobile phone education should also be provided to help senior volunteers understand how to operate and manage this service. It is also recommended that video programs be created to enable elderly men to build mutual relationships with a diverse group of friends and neighbors in the community as well as their family during COVID-19 era. In addition, online programs that regularly organize family gathering should be provided so that women can interact with family members. Finally, there is a need for measures to increase access to programs where women can participate in community service through internet-based technology. [ABSTRACT FROM AUTHOR]

Background: Little is known about how disease co-occurrences with common mental disorders (CMD) associate with social integration in young refugees. We identify diagnostic groups associated with labor market marginalization (LMM) in refugees and Swedish-born with CMD and determine whether multimorbidity is associated with LMM in young refugees and Swedish-born with CMD. Methods: This longitudinal registry-based study included adults aged 20- 25 years followed from 2011-2016 in Sweden. LMM was defined as > 180 days unemployment or being granted disability pension. A multimorbidity score was derived from a network of disease co-occurrences observed in 2009-2011. Relative risks for LMM in refugees with CMD compared to Swedish-born with CMD in 114 diagnostic groups were calculated. Multivariate logistic regression was applied to estimate the odds of LMM by CMD. Results: Among 249,245 young adults, 2,841 (1.1%) were granted disability pension and 16,323 (6.5%) individuals experienced unemployment, 20,679 (8.3%) suffered from CMD. Most comorbid diagnostic groups were positively associated with unemployment in young refugees with CMD. Inflammatory bowel disease and acute upper respiratory disease showed the highest relative risks of unemployment for young refugees with CMD, compared to Swedish-born with CMD: RRs 6.4[3.2, 12.8], 4.0[2.6, 6.1], respectively. The multimorbidity score was associated with elevated odds for unemployment and granted disability pension in refugees with/without CMD and Swedish born with/without CMD (OR range: 1.1-1.8; highest for young refugees without CMD). Conclusions: Specific diagnostic group had differential risks for unemployment for refugees and Swedish-born. Early culturally sensitive public health measures are warranted to target the detrimental consequences of multimorbidity on LMM in young adults. Key messages: The importance of diagnostic groups for LMM differs for young refugees and Swedish-born with CMD. Multimorbidity increases the risk for LMM, particularly disability pension. [ABSTRACT FROM AUTHOR]

Introduction: During COVID-19 pandemic, health-care workers (HCW) have been exposed to multiple psychosocial stressors. Although the problem of burnout, which overlaps with the symptoms of depression, remains urgent, few studies have addressed it comprehensively. The objective of this study was to determine the prevalence and the factors associated with burnout among HCW. Methodes: We conducted a cross-sectional study on March-April 2021 using a self-administered questionnaire distributed to HCW who were involved in COVID-19 management patients. The 22-item Maslach burnout inventory was performed to measure the prevalence of burnout defined as follows: high score of emotional exhaustion (≥27) plus high score of depersonalization (≥13) or low score of personal accomplishment (≤31). Results: Overall, 250 HCW were included in this study. The sex ratio was 0.17. Their median age was 34 years (interqurtile range (IQR)=[30-40 years]). The average number of work experience was 11.1≤3.4 years. There were 46 cases (18.4%) with a chronic disease. Among the study population, 131 HCW (51.4%) were infected with covid-19. The overall burnout prevalence was 45.6%. Female gender (Odds ratio (OR)=4.3; p<0.001) and unmarried status (OR=3.3; p<0.001) were statistically associated with burnout. Participants in the burnout group had statistically higher number of working hours per day (≤6hours) (OR=3.2; p=0.003), of night shifts per week (4±1 vs 3±1; p=0.04), but lower number of working experience years (7≥0.6 vs 12≤1; p=0.017). History of chronic diseases (OR=1.8;p=0.021), witnessing a COVID-19 death while working (OR=3.1; p<0.001) and suffering from sleep deprivation (OR=1.9; p=0.034) were statistically more frequent in the burnout group of HCW. Conclusions: The findings of this study indicated that the burnout syndrome was highly prevalent among HCW. More psychological support should be provided for this population in order to provide a high-quality of care for patients. [ABSTRACT FROM AUTHOR]

Work as a private primary health care practitioner with a special interest in older persons has been a rollercoaster ride over the course of the pandemic with the need to improvise, provide a wider form of care and an inordinate amount of role changing. The initial recommendation was to stay away from any possible cases which may have remotely resembled COVID with a view to keeping physicians and their practice safe. This message was unheard after the start of the second wave as the health services struggled to cope, testing became ever more accessible and patients who did develop COVID-19 needed someone to care for them when state services were overstretched. Meanwhile, the availability of all forms of specialist care grew ever scarcer in the community and increasingly caregivers such as myself realised that boundaries were now blurred under such circumstances. As hospital wards became taken up with exclusively COVID-19 patients, other hospital care delivery became on an urgent only basis and this had an effect on care in the community for patients living with chronic diseases. Physicians such as myself became ever more involved in caring for persons with mental illness and with the plethora of anxiety prevalent in a community burdened with a pandemic, an overabundance of morbid media coverage and social media feeding on fear and doubt. [ABSTRACT FROM AUTHOR]

Background Health workers have been at the forefront of treating and caring for patients with COVID-19. They were often under immense pressure to care for severely ill patients with a new disease, under strict hygiene conditions and with lockdown measures creating practical barriers to working. This study aims to explore the range of mental health, financial and other practical support measures that 36 countries in Europe and Canada have put in place to support health workers and enable them to do their job. Methods We use data extracted from the COVID-19 Health Systems Response Monitor (HSRM). We only consider initiatives implemented outside of clinical settings where COVID-19 patients are treated, and therefore exclude workplace provisions such as availability of personal protective equipment, working time limits or mandatory rest periods. Results We show that countries have implemented a range of measures, ranging from mental health and well-being support initiatives, to providing bonuses and temporary salary increases. Practical measures such as childcare provision and free transport and accommodation have also been implemented to ensure health workers can get to their workplace and have their children looked after. Other initiatives such as offering continuing professional development credits for knowledge learnt during the crisis were also offered in some countries, albeit less frequently. Conclusions While a large number of initiatives have been introduced, often as ad-hoc measures, their effectiveness in helping staff is unknown in most countries. The effectiveness of these initiatives should be evaluated to inform future crisis responses and strategies for health workforce development. [ABSTRACT FROM AUTHOR]