Search

Purpose: People with functional movement disorders (FMD) are commonly seen in neurology clinics. Despite a recent increase in research, no standardised treatment pathway across the UK exists. Currently only a few qualitative studies in FMD with a focus on psychological aspects and diagnosis have been published. This study aimed to understand people with FMD perceptions of their physiotherapy treatment. Method: Qualitative web-based interviews were conducted with seven participants and an interpretive phenomenological approach was used to identify themes from the data. Results: Four themes were identified; 1) my brain, mind and body are all me, 2) physiotherapy; what helps and what doesn't, 3) what recovery is to me, and 4) barriers to treatment. Participants desired a combination of psychological and physical approaches, which were holistic, individualised, and delivered by experienced physiotherapists. Limited availability and funding of specialist treatments were barriers to recovery. Conclusion: Holistic management combining psychological and physiological systems seems to be crucial for effective management of FMD. Large variations in physiotherapy treatment exist across the UK. It is hoped that increasing the understanding, amongst healthcare professionals will lead to the development of timely and appropriate pathways for patients that otherwise find themselves lost between medical specialities. IMPLICATIONS FOR REHABILITATION: Patients report more positive experiences when a combined and detailed psychological and physiological explanation to their symptoms is given. An individualised approach working with the patient on activities they find challenging is more preferable than group exercise or impairment based (e.g., strengthening/stretching) treatments. Having a physiotherapist who is experienced in treating functional movement disorders or prepared to learn and understand them helped with adherence to treatment. [ABSTRACT FROM AUTHOR]

This is a focused review of the most current publications and direct experiences of Military Sexual Trauma (MST) among veteran women and the lasting impact on this population's mental and physical health. This review covers the span of the last 5 years (2018-2023). Additionally, the review seeks to fill a gap in the literature to understand better how and if veteran women who have experienced MST use social media and online talk to form meaningful connections. A total of 13 studies were included in the final review. This review found many studies (5) further investigated the roles of gender, race, and interpersonal relationships in relation to MST experiences. This review did not find any current publications that sought to understand MST experiences that women veterans have shared through social media platforms. This type of online research in the future could help provide valuable new insight into the unique needs of MST survivors. [ABSTRACT FROM AUTHOR]

The article examines the implications of advanced artificial intelligence (AI) tools in healthcare and their impact on the traditional roles of physicians. Topics discussed include the ethical responsibility towards human labor in healthcare, the evolving patient-care system dynamic, and the need to rethink ethical considerations beyond physician-centric views.

Recent decades have witnessed the globalisation of policies promoting social cash transfers as a critical instrument for poverty reduction. Among various approaches, the Conditional Cash Transfer (CCT) model promoted by the World Bank has gained discursive dominance in countries where this strategy, and its technical model for implementation, appear more attractive than competing alternatives. While research has evaluated CCT programmes and considered the politics of development that they represent in Latin America, researchers are yet to explore the constitutive effects of CCT ways of knowing and measuring poverty in the societies of rural Asia. This paper explores the consequences of CCT knowledge politics in rural Indonesia. It argues that CCT practices of knowing and measuring have paradoxical effects. The programme makes direct payments to millions of impoverished households, producing well-documented patterns of inclusion and advancement. Yet, CCT knowledge practices involve simplifications and generate significant mis-targeting, eliciting a never-ending repair process among state actors, local leaders, and communities. This metricised knowledge system depoliticises political questions of distribution. It conceals alternative ways of knowing and addressing poverty, producing an order of entitlements somewhat at odds with established community logics of inclusion, while provoking a local politics of distribution. [ABSTRACT FROM AUTHOR]

Objective: The age of identification of hearing loss in children is highly influenced by the hearing help seeking behaviour of their parents, particularly in countries without universal newborn hearing screening programs. In this study, an attempt was made to identify the factors associated with help seeking behaviour in parents of children with hearing loss, and the relationship of such factors with the age of identification of hearing loss. Design: Focus group discussions based on the framework of health belief model were carried out. The discussions were transcribed and the transcripts were thematically analysed. Study sample: Participants were 35 parents of children with hearing loss from the state of Karnataka in India. Results: The findings revealed 30 factors related to their awareness about hearing loss, geographical location, socio-economic status, family, and society. The factors differed between early and late help seekers. Conclusions: Awareness, accessibility, and affordability are the key factors that influenced the hearing help seeking behaviour of the participants. Effective public awareness programs, newborn hearing screening programs, and provisions to make hearing healthcare affordable to all can reduce the age of identification of paediatric hearing loss in India. [ABSTRACT FROM AUTHOR]

The article discusses the development of audiology in Ghana, a West African country. Topics include the emergence of audiology in Ghana during the 1970s, the limited access to audiological services in the country, and importance of advancements in technology in addressing the rising demand for audiologists due to age-related hearing loss.

The article urges for the strengthening of neurodiagnostics in Africa and mobilization of students in research and workforce for sustainable impact to improve care for individuals with epilepsy. Topics discussed include challenges in neurodiagnostic access for epilepsy management, strategies for strengthening neurodiagnostics, and the need for collaboration to advance research on epilepsy and other neurological disorders.

Access to healthcare among Southeast Asian migrants in Taiwan is a pressing concern. Once migrants fall ill, they are at risk of losing jobs and even jeopardizing their legal status to work and stay. While existing studies have shed light on migrants' experiences of alienation in healthcare, there has been limited attention given to the role of migrant activists in negotiating and mobilizing concepts of health. In this article, I examine how activists mediate migrants' access to health resources. As migrant organizations step in to care for migrants, they render migrants' bodies legible and admissible by guiding them through the healthcare system. I suggest that activists wield the power to govern by shaping the ideals of a healthy and morally responsible migrant. Their authority to care also hinges upon crafting narratives of collective wellness that foreground the interdependent relationship between citizens and migrants, elevating migrants' health into vital projects of governance. Through a critical analysis of discourse and praxis around migrant care, my intention is not only to challenge the narrow focus on migrants' physical wellbeing but also to cast light on the affects of mediating care and how it shapes meanings and values attributed to migrants' lives. [ABSTRACT FROM AUTHOR]

Food insecurity is an established barrier to antiretroviral therapy (ART) adherence among people living with HIV (LWHIV). While insufficient access to food reliably impedes medication adherence, the link between food insecurity and ART nonadherence has not been fully explained. In addition, depression is reliably associated with both food insecurity and ART nonadherence, but again the link between food insecurity and depression is not understood. A potential explanatory mechanism in the associations among food insecurity, depression and ART nonadherence is the experience of food insecurity stigma (FI-stigma). The current study tested FI-stigma in relation to depression as explanatory mechanisms in the association between food insecurity and ART nonadherence. Men and women (n = 495) LWHIV in the southeastern United States completed confidential surveys that included measures of food insecurity, FI-stigma, depression, and ART adherence. Results from the serial mediation model indicated significant direct effects of food insecurity and depression on ART adherence. In addition, food insecurity was indirectly associated with ART adherence through FI-stigma and depression symptoms. Results suggest that the stigmatization of food insecurity predicts increased depression which in turn predicts ART nonadherence, with both FI-stigma and depression symptoms partially mediating the relationship between food insecurity and ART nonadherence. Interventions aimed to reduce food insecurity should include it's associated stigma to improve treatment adherence among people LWHIV. [ABSTRACT FROM AUTHOR]

Purpose: To summarize and critique research on the experiences and outcomes of sexual minority women (SMW) treated with surgery for breast cancer through systematic literature review. Methods: A comprehensive literature search identified studies from the last 20 years addressing surgical experiences and outcomes of SMW breast cancer survivors. Authors performed a quality assessment and thematic content analysis to identify emergent themes. Results: The search yielded 121 records; eight qualitative studies were included in the final critical appraisal. Quality scores for included studies ranged 6-8 out of 10. Experiences and outcomes of SMW breast cancer survivors were organized by major themes: 1) Individual, 2) Interpersonal, 3) Healthcare System, and 4) Sociocultural and Discursive. Conclusions: SMW breast cancer survivors have unique experiences of treatment access, decision-making, and quality of life in survivorship. SMW breast cancer survivors' personal values, preferences, and support network are critical considerations for researchers and clinicians. [ABSTRACT FROM AUTHOR]

Climate change affects the spread of waterborne infectious diseases, yet research on vulnerability to outbreaks remains limited. This integrative review examines how climate variables (temperature and precipitation) relate to human vulnerability factors in Pakistan. By 2060, mean temperatures are projected to rise from 21.68°C (2021) to 30°C, with relatively stable precipitation. The epidemiological investigation in Pakistan identified Diarrhea (119,000 cases/year), Malaria (2.6 million cases/year), and Hepatitis (A and E) as the most prevalent infections. This research highlighted vulnerability factors, including poverty (52% of the population), illiteracy (59% of the population), limited healthcare accessibility (55% of the population), malnutrition (38% of the population), dietary challenges (48% of the population), as well as exposure to water pollution (80% of the population) and air pollution (55% of the population). The findings suggest that the coordinated strategies are vital across health, environmental, meteorological, and social sectors, considering climatic variability patterns and population vulnerability determinants. [ABSTRACT FROM AUTHOR]

The purposes of the present study were a) to evaluate the construct validity of a questionnaire measuring parental physical activity (PA) orientation, and b) to examine the association between constructs of parental PA orientation and parental explicit PA modelling in parents of young children with disabilities. One hundred and thirty-five participants completed an online questionnaire. Exploratory factor analysis was used to examine the construct validity of a questionnaire for parental PA orientation. Exploratory factor analysis for parental PA orientation revealed a four-factor solution, accounting for 59.02% of the variance with eigenvalues of 7.14, 6.88, 4.00, and 2.35 for factor 1 (parent-perceived motor performance of their child), factor 2 (parental enjoyment of PA), factor 3 (parental importance of PA), and factor 4 (parental awareness of accessible PA program), respectively. Two hierarchical multiple regression models were developed and used to examine the association between constructs of parental PA orientation and parental explicit PA modelling. Parental enjoyment and importance of PA were significant factors predicting parental explicit PA modelling, controlling for child's age and parent's age. The results of the current study may be used for resources when developing an intervention for parental explicit PA modelling in parents of children with disabilities. [ABSTRACT FROM AUTHOR]

One of the major impacts of hearing disability that hinders the individual's effective participation in society and full enjoyment of human rights and fundamental freedoms is his/her ability to communicate with others. Sign language is one of the main methods of communication used by people with hearing disability. Therefore, improving access to sign language services and increasing the availability of interpreters contribute to better inclusion and integration of people with hearing disability into society. This paper explores the experience of a Jordanian university that launched a pioneering initiative by offering a sign language course for its students. It reports the findings of a study that evaluated this initiative from the perspective of students. Feedback was recorded during unstructured interviews with 23 student participants who had taken the course. The paper concludes that universities can play a significant role in integrating people with disabilities into the education system and promoting their participation in society. [ABSTRACT FROM AUTHOR]

Unpaid carers are a significant support for dependent people with chronic illnesses in most countries. Working carers have specific needs because they face a conflict between employment and care. This study reports on the views of seven working carers in Taiwan to discover the factors they might have considered when arranging publicly funded Long-Term Care (LTC) services for the person they care for to reconcile their work and care. According to the testimony of working carers, the issue of safety for care recipients motivates the application for LTC services. However, LTC services in Taiwan, while affordable, are limited. Working carers have a positive attitude towards home care due to its low price and flexible service time. The constructed barriers to accessing daycare make it difficult for families to use daycare, even though it may be the most suitable service for care recipients. The findings have implications for improvements in LTC services. They show that an extension of opening hours of daycare is needed to meet the employment needs of working carers and that care skill training should be offered for providers of LTC services. [ABSTRACT FROM AUTHOR]

The 2022 Russian invasion of Ukraine has caused serious challenges for healthcare workers (HCWs) and HIV-related healthcare services. This study assessed the effects of the invasion on HCWs wellbeing and on continuity of HIV services, using in-depth interviews with HCWs from facilities offering HIV antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) services in the Donetsk region of Eastern Ukraine. A directed content analysis, with both inductive and deductive approaches, was conducted. Ten HCWs (6 [60%] doctors, 4 [40%] nurses; 9 [90%] female) were interviewed. Six respondents were displaced from their homes and worksites, and all described stress and threats to emotional wellbeing. HCWs used online consultations, encrypted mobile communication, and multi-month dispensing to support continuity of ART and PrEP services. They noted immediate needs for psychological and financial support, and access to laptop computers and mobile communications to ensure continuity of HIV services. Priorities for restoration of services include repair of health facilities, restoration of laboratory services and supply chains, and return of personnel and patients. HCWs made innovative, rapid adaptations to HIV services to keep ART and PrEP services running, demonstrating the resolve of Ukrainian HCWs to maintain continuity of HIV services despite the disruptions of war. [ABSTRACT FROM AUTHOR]

People with disabilities (PWD) are thought to be low risk for HIV because of social norms regarding disability and sex. However, qualitative studies indicate they are at risk and are not being reached by HIV programs. The Demographic and Health Survey (DHS) conducted in Haiti in 2016 included HIV biomarker data and disability status. Crude and adjusted odds ratios were calculated using a disability severity indicator as the independent variable and HIV infection as the dependent variable. Covariates were selected based on theory and previous studies. Individuals reporting milder disabilities had a higher odds of HIV infection in the crude model (OR:1.65; CI: 1.16-2.34) and those adjusted for demographics (OR:1.73; CI:1.19-2.51) and sexual activity (OR:1.60; CI:1.06-2.42). Those with moderate and more severe disabilities have the same odds of HIV infection as the general population. PWD are HIV-positive and at risk of HIV infection. Based on this, it is essential that HIV education, testing, and treatment programs are inclusive of PWD. Accessible HIV education materials need to be created. HIV testing programs should involve PWD in planning and implementation. Providers of HIV care must be trained regarding the needs of PWD for reproductive healthcare. [ABSTRACT FROM AUTHOR]

This study aims to understand the impact of chronic conditions on perceived health and well-being among rural, community-dwelling older adults and to identify the barriers and supports impacting the perceived health and well-being among this population. A convergent mixed-methods design was conducted using the Pizzi Health and Wellness Assessment (PHWA) and semi-structured interviews. Participants' feelings about their health on the PHWA highlighted positive familial (M = 9.67, SD = 1), social (M = 8.67, SD = 1.12), occupational (M = 8.67, SD = 1.94), and spiritual (M = 8.56, SD = 2.13) health. Qualitative analysis revealed overarching themes: the impact of rural living and factors affecting health and well-being. Community-dwelling older adults with chronic conditions perceived their health and well-being as impacted by benefits and barriers of rural living. Positive perceptions of health and well-being were connected to family and social support, spirituality, and meaningful occupations. [ABSTRACT FROM AUTHOR]

The United Nations Convention on the Rights of Persons with Disabilities and the Sustainable Development Goals stipulate that persons with disabilities have equal rights to access and safely use transport systems. The aim of the current study is to explore stakeholders' perspectives of the relationship and prioritization between safety and accessibility in the Swedish discussion of disability and transport. The data consist of interviews with 15 informants from the National Council for Disability and Transport and other key stakeholders. Reflexive thematic analysis led to identification of four themes: basis for priorities is a matter of governing; challenges to measuring and evaluating different values; importance of knowledge and building forums; and a universal system of accessibility and safety is a challenge. The results indicate the road ahead for a possible holistic and sustainable governance in the transport systems. However, how this will be put into practise is not yet defined. Points of interest: According to several regulations, persons with disabilities have equal rights to safety and accessibility in the transport system. However, there are challenges to combining different concepts and perspectives. Lack of mandates for institutions to address both safety and accessibility leads to goal conflicts and a risk that focuses become entrenched with clearly defined boundaries. There are challenges in evaluating different values and perspectives in relation to accessibility. A facilitating aspect for sustainability regarding safety and accessibility is to create opportunities and systems to allow for the exchange of knowledge. Integration of safety and accessibility may be encouraged by the use of existing sets of holistic approaches (i.e. Vision Zero and Universal Design). [ABSTRACT FROM AUTHOR]

This article examines the gap between the theory and practice of person-centered services for adults with intellectual disabilities in the United States. It explores the rhetoric of personalized services—it gives a history of social care, rehearses the logic of person-centered planning and outlines the tension of conflicting disability policies. Then it defines the nature of choice and explains how limited alternatives undermine choice. Next the article describes the reality of restricted service options, summarizing the conclusions of a survey of American families and a meta-review of the effectiveness of person-centered planning. After recapping the contrast between rhetoric and reality, objections to the analysis are addressed. Finally, the article offers solutions for service system transformation. While the thesis pertains to the United States, its lessons are applicable to other nations. Points of interest: In recent years, supports for adults with intellectual disabilities have been shifting from a system based on what is available from service agencies to an approach that is tailored to individual needs and wants. Choice in services requires having multiple options from which to choose. There is a gap between theory and practice in the United States. Laws and regulations require services based on individual needs and wants, yet in many cases this is not reality. Because of many social factors, people with intellectual disabilities are fit into standard service packages rather than having supports matched to their individual needs and wants. Change in multiple social systems is necessary to create personal supports and choice in services. [ABSTRACT FROM AUTHOR]

This study describes medical interpreters' experiences with behavioral health (BH) services in a primary care clinic. Focus group data with medical interpreters representing multiple languages was analyzed using hybrid inductive-deductive thematic analysis. Themes related to interpreter roles were: (1) case management, (2) patient-interpreter relationship, and (3) patient-provider liaison. Themes related to barriers and facilitators to interpreter-mediated BH care were: (1) cultural factors, (2) patient-provider interactions, (3) BH-specific considerations, and (4) clinic factors. Results illustrate ways that interpreters directly (e.g. interpreter-mediated services) and indirectly (e.g. relationship building) support care. The interpreter-patient relationship reportedly helped improve patient attitudes and buy-in for BH. [ABSTRACT FROM AUTHOR]

Young people in rural, regional, and remote communities experience high levels of mental distress. Health services in rural and remote communities are also poorer in quality. Hence, it is critical to understand how social work can help young people in these areas access mental health supports. This scoping review identifies what enables and hinders access to mental health services for young people in rural, regional, and remote areas of Australia and Canada. Twenty-two studies published between 2018 and 2022 were included and analyzed. Findings highlight the need for social workers to reduce peer-stigmatization of mental illness and foster community collaboration. [ABSTRACT FROM AUTHOR]

The novel coronavirus pandemic (COVID-19) required substantial changes in socialization to mitigate the spread of the virus. Stay-at-home and social distancing mandates required changes in work, school, and healthcare access for autistic adults. This qualitative online netnographic study utilized a public online forum to examine 1,102 posts detailing the experiences of COVID-19 by autistic adults from March 2020 to December 2020. We found two main themes related to seeking behavioral health services and seeking support related to service delays and barriers during the COVID-19 pandemic. Implications for social work practice and supporting autistic people in navigating healthcare access are discussed. [ABSTRACT FROM AUTHOR]

There is currently limited research related to mental health supports for individuals who use AAC, particularly about the actual lived experiences of AAC users who receive mental health services. There may be alterations to mental health services for individuals who use AAC. The aim of this study was to gain the perspectives of AAC users on accessing and receiving mental health services. Three participants who used AAC and received mental health services shared their experiences related to receiving mental health services. Data were analyzed using an inductive approach in which themes were based on participants' experiences. Five major themes were generated: (a) Time, (b) Communication Partner Skills, (c) Advocacy, (d) Means of Expression, and (e) Diagnosis. Participants described factors that positively or negatively impacted their experiences. Participant experiences were examined in light of Bronfenbrenner's Ecological Systems model. The findings of this study provide insights into the perspectives of individuals who use AAC in accessing mental health services, uncovering various barriers and facilitators within the patient–psychotherapist microsystem. Factors such as time constraints, communication partner skills, advocacy, means of expression, and diagnosis-related challenges significantly influenced the quality of interaction between patients using AAC and their mental health provider. The study also reveals the broader impacts of AAC on interactions within the meso-, exo-, and macro-systems, suggesting the need for improved involvement of speech-language pathologists and policy changes to support effective communication and accessibility for individuals using AAC in mental health settings. Ultimately, future research should involve participants of varying ages, diagnoses, and backgrounds and should include a variety of stakeholders. [ABSTRACT FROM AUTHOR]

The child welfare system's method of service delivery shifted abruptly during the pandemic to a telehealth modality. The perceived impact of this change upon service delivery is largely unknown, however. The purpose of this study was to describe how a large child welfare agency shifted to telehealth delivery, including investigating barriers and innovative strategies that were undertaken to resolve obstacles and enhance engagement and the provision of services. In September, 2020, direct service providers, supervisors and clinic directors at a large, Southeastern child welfare agency completed a survey that tapped into the perceived impact of telehealth on service delivery, and barriers and benefits of telehealth delivery. Twenty-six (n = 26) individuals completed the survey. Over half of participants reported an improvement in service delivery through the use of telehealth, and most saw it as being beneficial to both families and staff. Few participants believed that services were negatively impeded by telehealth.The main barrier to telehealth delivery was technology access and navigation (both on the part of families and staff). Telehealth was largely perceived as a facilitator to child welfare service delivery; implications and use of remote platforms are discussed. [ABSTRACT FROM AUTHOR]

Background and aims: Long pre-hospital delay substantially increases the likelihood of perforated appendicitis. This study aimed to find patient-related factors affecting this delay. Methods: A survey was conducted for patients with acute appendicitis after appendectomy. The participants were asked about their path to the surgical center and socioeconomic status. Variables affecting delays and the rate of complicated appendicitis were analyzed. Results: The study included 510 patients; 157 (31%) had complicated appendicitis with a median prehospital delay of 42 h. In patients with uncomplicated appendicitis, the delay was 21 h, p <.001. Forty-six (29%) patients with complicated appendicitis were not referred to the hospital after the first doctor's visit. The multivariate analysis discovered factors associated with long pre-hospital delay: age 40–64 years (OR 1.63 (95% CI 1.06–2.52); compared to age 18–39), age more than 64 years (OR 2.84 (95% CI 1.18–6.80); compared to age 18–39), loss of appetite (OR 2.86 (95% CI 1.64–4.98)), fever (OR 1.66 (95% CI 1.08–2.57)), non-referral by helpline nurse (OR 2.02 (95% CI 1.15–3.53)) and non-referral at first doctors visit (OR 2.16 (95% CI 1.32–3.53)). Age 40–64 years (OR 2.41 (95% CI 1.50–3.88)), age more than 64 years (OR 8.79 (95% CI 2.19–35.36)), fever (OR 1.83 (95% CI 1.15–2.89)) and non-referral at first doctors visit (OR 1.90 (95% CI 1.14–3.14)) were also risk factors for complicated appendicitis. Conclusions: Advanced age, fever and failure to suspect acute appendicitis in primary care are associated with prolonged pre-hospital delay and complicated appendicitis. [ABSTRACT FROM AUTHOR]

Purpose: Improving quality of life (QoL) is a major goal of rehabilitation following spinal cord injury (SCI). However, people with disabilities in resource constrained contexts have limited access to rehabilitation and poorer health outcomes, including QoL. There is a paucity of qualitative research on the experiences of persons with SCI involved in rehabilitation programmes in low-middle income countries. This study aimed to assess participants' perceptions of the benefits of a 24-week SCI rehabilitation programme delivered as part of a pilot randomized controlled trial (RCT) in South Africa. Materials and methods: Sixteen participants, with chronic motor-incomplete tetraplegia, were enrolled in a two-arm pilot RCT involving robotic locomotor training, a novel technology, and standard activity-based training (Pan African Clinical Trial Registry (PACTR201608001647143)). Data were collected via in-depth interviews and analysed using thematic analysis. Results: Participants described several improvements in QoL, including enhanced functional independence; reduced secondary complications; and improved psychosocial and emotional well-being. Conclusions: The holistic approach to rehabilitation calls for the involvement of individuals' views about what matters to them to inform clinical practice and to highlight the role that physical activity and the perceived successes play in shaping the lived experiences after SCI. Trial registration: Pan African Clinical Trial Registry (PACTR201608001647143), registration date (21st May 2016), study start date (30th Nov 2016) IMPLICATIONS FOR REHABILITATION: Rehabilitation plays an integral role in prompting and integrating positive experiences and changes in QoL for people with spinal cord injury (SCI), especially in a resource constrained context where there is limited opportunity to participate in rehabilitation interventions. Locomotor training and activity-based training can enhance perceived functional independence and psychosocial well-being following SCI. Rather than focus on traditional physiological outcomes, rehabilitation interventions can address quality of life outcomes in order to improve well-being in a way that is meaningful to people with SCI. [ABSTRACT FROM AUTHOR]

Most stroke survivors have ongoing deficits and report unmet needs. Despite evidence that rehabilitation improves stroke survivors' function, access to occupational and physical therapy is limited. Describing access to care for disadvantaged communities for different levels of stroke severity will provide proportions used to create Markov economic models to demonstrate the value of rehabilitation. The objective of this study was to explore differences in the frequency of rehabilitation evaluations via outpatient therapy and home health for Medicare Part B ischemic stroke survivors in rural and socially disadvantaged locations. We completed a retrospective, descriptive cohort analysis using the 2018 and 2019 5% Medicare Limited Data Sets (LDS) from the Centers for Medicare and Medicaid Services using STROBE guidelines for observational studies. We extracted rehabilitation Current Procedural Terminology (CPT) codes for those who received occupational or physical therapy to examine differences in therapy evaluations for rural and socially disadvantaged populations. Of the 9,076 stroke survivors in this cohort, 44.2% did not receive any home health or outpatient therapy. Of these, 64.7% had a moderate or severe stroke, indicating an unmet need for therapy. Only 2.0% of stroke survivors received outpatient occupational therapy within the first year Rural and socially disadvantaged communities accessed rehabilitation evaluations at lower rates than general stroke survivors. These findings describe the poor access to home health and outpatient rehabilitation for stroke survivors, particularly in traditionally underserved populations. These results will influence future economic evaluations of interventions aimed at improving access to care. [ABSTRACT FROM AUTHOR]

determinants of access to rehabilitation professionals after stroke in middle-income countries, where the burden of this disease is higher, are little known. To identify the determinants of access to rehabilitation professionals by individuals with stroke at one, three, and six months after hospital discharge in Brazil and compare referral and access rates after discharge. Longitudinal and prospective study, with individuals with primary stroke, without previous disabilities. At hospital discharge, the number of rehabilitation professionals referred by the multidisciplinary team was recorded. The possible determinants of access, according to Andersen's model, were: a) predisposing factors: age, sex, education levels, and belief that they could improve with treatment; b) need factors: stroke severity, levels of disability; c) enabling factors: socioeconomic status, disposable income for health care, and quality of care provided by rehabilitation professionals. One, three, and six months after hospital discharge, individuals were contacted to identify which rehabilitation professionals were accessed. Multiple linear regression model and Wilcoxon tests were used (α=5%). 201 individuals were included. Disability levels and stroke severity explained 31%, 34%, and 39% (p<0.01) of access at one, three, and six months after hospital discharge, respectively. In all periods, there was less access than that recommended at the time of hospital discharge (p<0.01). Need factors (disability levels and stroke severity) were determinants of access in all assessed periods. In addition, in all periods, the comprehensiveness of care for individuals with stroke was compromised. [ABSTRACT FROM AUTHOR]

Parents have long been concerned with the transition to adulthood of their children with intellectual and developmental disability (IDD) particularly with financial issues. The purpose of this study was to explore the financial concerns of mothers of adults with IDD. Five mothers of adults with IDD participated in a focus group to share their experiences, opinions, concerns, and challenges related to finances. Five themes emerged from the qualitative data analysis: (a) job-related difficulties, (b) living expenses, (c) access to essential services, (d), skills deficits and/or challenging behavior, and (e) long-term care. Mothers in general indicated tremendous financial burdens, loss of income, and expressed concerns about long-term care of their children with IDD. These themes are discussed and implications for practice and research are provided. [ABSTRACT FROM AUTHOR]

Background: Type 1 Diabetes (T1D) requires consistent disease management for blood sugar regulation. A theoretical framework can assist with interpreting behavioral processes needed for disease management. However, limited qualitative studies have explored disease management practices among college students with T1D using a theoretical framework. Purpose: To theoretically explore college students' engagement in T1D self-care behaviors to further understand disease management experiences. Methods: One-on-one interviews with 31 full-time college students attending universities in the Southeastern United States. A thematic analysis was conducted to generate subthemes. Results: Subthemes explained self-care maintenance behaviors performed daily (i.e. carry supplies, administer insulin), self-care monitoring behaviors (e.g. analyzing blood sugar trends), and how self-care behaviors were adjusted when previous behaviors were no longer effective for blood sugar regulation. Discussion: Although participants routinely performed T1D self-care behaviors, additional information is needed on how technology is used for self-care monitoring. Future studies should explore college students' T1D self-care management behaviors to determine strategies that are used to improve their blood sugar. Translation to Health Education Practice: Findings from this study can assist health education specialists and healthcare professionals with creating interventions to support disease management among college students living with T1D. [ABSTRACT FROM AUTHOR]

Improving health and safety in our communities requires deliberate focus and commitment to equity. Inequities are differences in access, treatment, and outcomes between individuals and across populations that are systemic, avoidable, and unjust. Within health care in general, and Emergency Medical Services (EMS) in particular, there are demonstrated inequities in the quality of care provided to patients based on a number of characteristics linked to discrimination, exclusion, or bias. Given the critical role that EMS plays within the health care system, it is imperative that EMS systems reduce inequities by delivering evidence-based, high-quality care for the communities and patients we serve. To achieve equity in EMS care delivery and patient outcomes, the National Association of EMS Physicians recommends that EMS systems and agencies: make health equity a strategic priority and commit to improving equity at all levels. assess and monitor clinical and safety quality measures through the lens of inequities as an integrated part of the quality management process. ensure that data elements are structured to enable equity analysis at every level and routinely evaluate data for limitations hindering equity analysis and improvement. involve patients and community stakeholders in determining data ownership and stewardship to ensure its ongoing evolution and fitness for use for measuring care inequities. address biases as they translate into the quality of care and standards of respect for patients. pursue equity through a framework rooted in the principles of improvement science. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

AbstractThe proliferation of online information sources, particularly regarding sex and sexuality, presents challenges for young people, educators, and policymakers in understanding how different cultural, socioeconomic, and minority groups access this information. The study explores disparities in seeking information about sex and sexuality among Arab and Jewish Israeli young adults. Findings from a survey of 303 participants aged 18–40 show that Jewish young adults consult more information sources than do Arab young adults. Socioeconomic status, gender, age, and religious status predict the sources used. The study emphasizes cultural and ethnic variations in healthcare access. Suggestions include culturally tailored sexuality education. [ABSTRACT FROM AUTHOR]

Stressful experiences are common among migrants and may have health implications. With the only US nationally representative data set on migration, the New Immigrant Survey, we used survey-adjusted descriptive and multivariate regression methods to examine whether victimization prior to resettlement was associated with obesity, cardiovascular disease, diabetes, arthritis, cancer, and chronic lung disease. Among foreign-born people who obtained lawful permanent residence in the US in 2003–04, 6.7 per cent reported victimization before arriving in the US. Those who had experienced victimization more often suffered from chronic conditions than people without such experiences: they were 32 per cent more likely to suffer from at least one chronic condition (p < 0.05), especially cancer (4.36, p < 0.05), arthritis (1.77, p < 0.01), and cardiovascular disease (odds ratio 1.32, p < 0.05). These relationships were in part mediated by differences in healthcare access after arriving in the US between those who had experienced victimization and those who had not. Victimization may have consequences for integration and later-life chronic disease. [ABSTRACT FROM AUTHOR]

Abstract Recent advances in development of amyloid-targeting therapies support the potential to slow the rate of progression of Alzheimer’s disease. We conducted a narrative review of published evidence identified through a targeted search of the MEDLINE and EMBASE databases (2020–2023), recent presentations at disease-specific conferences, and data updates from cohort studies in Alzheimer’s disease to describe the trajectory of the progression of Alzheimer’s disease. Our findings enable the interpretation of clinical trial results and the value associated with slowing disease progression across outcomes of relevance to patients, care partners, clinicians, researchers and policymakers.Even at the earliest stages, Alzheimer’s disease imposes a substantial burden on individuals, care partners, and healthcare systems. The magnitude of the burden increases with the rate of disease progression and symptom severity, as worsening cognitive decline and physical impairment result in loss of functional independence. Data from cohort studies also indicate that slowing disease progression is associated with decreased likelihood of needing extensive clinical care over at least 5 years, decreased care partner burden, and substantial individual and societal cost savings.Slowed disease progression is of significant benefit to individuals with Alzheimer’s disease, their loved ones, and the healthcare system. As clinicians and policymakers devise strategies to improve access to treatment earlier in the disease spectrum, they should carefully weigh the benefits of slowing progression early in the disease (e.g. preservation of cognitive and functional abilities, as well as relative independence) to individuals, their loved ones, and broader society. [ABSTRACT FROM AUTHOR]

Objective: Underreporting of adolescent substance use is a known issue, with format of assessment (in-person vs. remote) a potentially important factor. We investigate whether being assessed remotely (via phone or videoconference) versus in-person affects youth report of substance use patterns, attitudes, and access, hypothesizing remote visits would garner higher levels of substance use reporting and more positive substance use attitudes. Methods: We used the Adolescent Brain and Cognitive DevelopmentSM [ABCD] Study data between 2021-2022 during the COVID-19 pandemic. Participants chose whether to complete assessments in-person (n=615; 49% female; meanage=13.9; 57% White) or remotely (n=1,467; 49% female, meanage=13.7; 49% White). Regressions predicted substance use patterns, attitudes, and access, by visit format, controlling for relevant sociodemographic factors. Effect sizes and standardized mean differences are presented. Results: 17% of adolescent participants reported any level of substance use. Youth interviewed remotely reported more negative expectancies of alcohol and cannabis. In addition, those queried remotely were less likely to endorse use), sipping alcohol, eating cannabis), and reported less curiosity or intent to try alcohol, though these differences did not survive an adjustment for multiple testing. Effect sizes ranged from small to medium. Conclusions: Preliminary evidence suggests youth completing remote visits were more likely to disclose negative expectancies toward alcohol and cannabis. Effect sizes were modest, though 37 of 39 variables examined trended toward restricted reporting during remote sessions. Thus, format of substance use assessment should be controlled for, but balanced by other study needs (e.g., increasing accessibility of research to all sociodemographic groups). [ABSTRACT FROM AUTHOR]

AbstractObjective: Although there are many international college students in the state of Georgia, few studies have been conducted on how social determinants affect their health outcomes and academic success. This study examined the effects of social determinants on the health outcomes and academic success of international college students in Georgia. Participants: Participants were international college students (n = 136) in Georgia. Methods: A mixed methods cross-sectional design was used for the study. Results: The lack of access to sufficient funds caused study participants to experience anxiety (39.0%), depression (20.6%), and stress (52.9%). Cultural differences (16.9%), lack of access to health care (15.4%), transportation (14.7%), poor housing (7.4%), and financial insecurity (54.5%) affected study participant health outcomes and academic success. Conclusion: Addressing financial insecurity, the lack of access to health care, poor housing, transportation issues, and cultural differences experienced by international college students in Georgia, is crucial to their health outcomes and academic success. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodResultsConclusionThe objective of this paper is to explore how telephone-delivered mindfulness training impacts family conflict and communication within the informal dementia caregiving team, including primary caregivers, their care partner, and the care recipient.Primary caregivers and their care partners participated in an eight-week telephone-delivered mindfulness-based intervention (MBI). This study used mixed methods and a pre-post design to evaluate the intervention’s effect on family satisfaction, perceived support, and family conflict.Both family satisfaction and perceived informational support increased significantly, and qualitative analysis revealed four key themes illustrating how the mindfulness intervention served to positively impact family conflict and communication among participating caregivers.This study provides preliminary evidence for the beneficial effects of an MBI on family functioning among rural African American caregivers of people with Alzheimer’s disease and related dementias. [ABSTRACT FROM AUTHOR]

Purpose: Asian children and youth with disabilities often experience multiple barriers, stigmas and discrimination within and outside their families; yet less is understood about their lived experiences. This systematic review explored the experiences of ableism among Asian children and youth with disabilities and their families. Methods: We conducted a systematic review of qualitative studies and a qualitative meta-synthesis. We searched six databases including Ovid Medline, Embase, PsychInfo, Healthstar, Web of Science, and Scopus. Results: Forty-two articles met our inclusion criteria involving 17 countries and regions over a 22-year period. The findings were synthesized into four themes: (1) individual- and family-level ableism (i.e., stigma, fears, concerns, stress and anxieties, physical abuse, bullying, reduced engagement in community activities); (2) institutional-level ableism (i.e., barriers to accessing and navigating supports, ableist attitudes among service providers, unavailable services); (3) societal-level ableism (i.e., cultural and religious stigma, social rejection, discrimination, environmental and policy barriers); and (4) coping strategies (i.e., self-care activities, supports from family, friends and people with similar conditions, religious beliefs). Conclusions: Our results highlight the ableist experiences that Asian children and youth with disabilities and their caregivers often encounter and the strong need for further supports to address ableism using culturally responsive strategies. IMPLICATIONS FOR REHABILITATION: Asian children and youth with disabilities encounter multiple forms of ableism at the individual, family and institutional levels. It is important for healthcare providers to customize resources that are culturally appropriate and aligned with the cultural and language backgrounds of the clients they serve. Clinicians and service providers should engage in culturally sensitive training and education to understand the barriers faced by the clients they serve. Clinicians and service providers should continue to advocate for marginalized and equity-deserving groups. [ABSTRACT FROM AUTHOR]

Purpose: To develop a new instrument to identify barriers to self-administered home-based task-oriented practice post-stroke and test its content validity. Materials and methods: The sample consisted of individuals with stroke and neurological rehabilitation professionals. The study consisted of two steps: (1) Instrument development, involving three processes; a data search in the literature, interviews with the target population and an open questionnaire (online) sent to professionals; and (2) Testing the content validity of the instrument by asking individuals with stroke and professionals about the comprehensiveness and relevance of the items and additionally asking individuals with stroke about the comprehensibility of the items. For each item in the instrument, the threshold validity scores were ≥0.80 in the Content Validity Index and ≥0.75 for the Kappa agreement. Results: The preliminary version was developed with 46 items. The content validation was performed in three rounds. The last version of the instrument Barriers to self-administered home-based task-oriented practice post-stroke (BASH-TOP-Stroke) contained 34 items in five response categories, in which the higher the value presented, the greater the number of barriers. The content validity for the items was excellent. Conclusions: The study provides a new instrument to help identify barriers to self-administered home-based task-oriented practice post-stroke. IMPLICATIONS FOR REHABILITATION: Barriers to self-administered task-oriented home-based exercises can be specific to this form of practice. Understanding barriers to self-administered task-oriented home-based exercises is essential to increase the amount of practice for optimizing motor recovery. The Barriers to self-administered home-based task-oriented practice post-stroke (BASH-TOP-Stroke) questionnaire was developed to evaluate barriers to self-administered task-oriented home-based exercises in individuals post-stroke. BASH-TOP-Stroke has excellent content validity based on patients and professionals and could help to identify strategies that may reduce barriers to self-administered home-based task-oriented practice after stroke. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionDespite global declines in asthma mortality, regional variations and sex disparities persist. This study investigates asthma mortality trends in Spanish Autonomous Communities (ACs) from 1980 to 2022, analyzing data by sex.Data on asthma deaths and population were obtained from the National Institute of Statistics for the study period. Age-standardized mortality rates (ASMRs) were calculated, and joinpoint regression models were applied to identify trends.Overall, 44,728 asthma deaths occurred, with a steeper decline observed in men (−3.5% per year) compared to women (−0.7% per year). The female-to-male mortality ratio climbed from 0.7 in 1980 to 5.4 in 2016. Both sexes exhibited a significant decrease in ASMRs, with a more substantial decline in males (−6.3%).While all ACs showed a significant decrease in male ASMRs, female trends varied, with significant decreases in 13 ACs and stable trends elsewhere. Joinpoint analysis revealed diverse regional patterns for both sexes, with some ACs experiencing steady declines and others exhibiting periods of slower decline or even stabilization.This study identified concerning regional and sex disparities in Spanish ACs’ asthma mortality (1980–2022). While male rates declined significantly across all regions, female rates showed variation, with even increases in some ACs. Targeted interventions addressing these disparities and their underlying causes (healthcare access, management practices, etc.) are crucial. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodResultsConclusionCOVID-19 lockdowns were introduced to control the pandemic, however, they resulted in a global disruption of daily life and of individual and global health. Reduced accessibility of health services, unavailability of food and drugs, and mental health challenges had a huge impact on older people and on people living with disabling conditions such as Parkinson’s disease (PD). We assessed whether and to what extent the more disabled and vulnerable people with Parkinson’s (PwP) were affected by lockdowns.We analysed responses collected through a web-based survey of PwP according to their self-sufficiency [self-sufficient (SS); nearly self-sufficient (nSS); non-self-sufficient, cared for by family (NSS/F); non-self-sufficient, needs professional care (NSS/PC)].Fears due to COVID-19 and difficulties with food supply were highest in NSS/F PwP. Difficulties with the supply of Parkinson’s medication or other drugs were apparently not an issue, while problems accessing primary care physicians and neurologists were similar across all patient groups. On the contrary, difficulties with daily and motor activities were higher in NSS/F and NSS/PC PwP. PwP symptoms worsened in all groups, with NSS/F and NSS/PC participants experiencing the worst deterioration. Notably, the deterioration of PwP symptoms was specifically related to changes in daily and motor activities, with participants who reported less engagement in daily and motor activities experiencing the worst deterioration.Findings strongly support the need for decision-makers and healthcare providers to carefully re-evaluate the risk–benefit ratio of limiting healthcare accessibility for PwP, since evidence shows that lockdown measures primarily impact the groups who are most fragile and vulnerable. [ABSTRACT FROM AUTHOR]

The struggle to distinguish a clear professional identity has been an ongoing issue for counselling psychology. In Australia, this struggle has been associated with discrepancies between the definition and competencies of counselling psychologists. This is further exacerbated by the overlap between clinical and counselling psychologists' scopes of practice. This research contributes to the ongoing discussion surrounding the similarities and differences between clinical and counselling psychology. A web-based survey was distributed to Australian counselling psychologists (n = 290) seeking information regarding respondents' demographics and their perceptions of the similarities and differences between clinical and counselling psychology. Reflexive thematic analysis generated three key themes: 1) overlap in the scope of practice and competencies of clinical and counselling psychologists; 2) the philosophy of counselling psychology; and 3) the negative impact of the Better Access scheme on counselling psychology. These findings indicated that despite overlap across core competencies, counselling psychologists perceive they are a distinct area of practice to clinical psychology. In identifying counselling psychologists' perceptions of the similarities and differences between the two areas of practice endorsement, this study has the potential to clarify scopes of practice and perceived competencies. What is already known about this topic: Professional identity has been identified as an issue for Australian counselling psychologists. A lack of clarity exists over counselling psychology's similarities and differences with clinical psychology. No prior comparisons of similarities and differences between the two areas of practice endorsement have been published with Australian psychologists. What this topic adds: Participants perceive an overlap in the competencies and scope of practice of clinical and counselling psychologists. Counselling psychologists perceive a unique philosophy and orientation to practice. External factors, such as funding schemes, have negatively impacted on public understanding and recognition of counselling psychology. [ABSTRACT FROM AUTHOR]

COVID-19 has affected healthcare in profound and unprecedented ways, distorting the experiences of patients and healthcare professionals (HCPs) alike. One area that has received little attention is how COVID-19 affected HCPs caring for dying patients. The goal of this study was to examine the experiences of HCPs working with dying patients during the COVID-19 pandemic. Between July 2020–July 2021, we recruited HCPs (N = 25) across Canada. We conducted semi-structured interviews, using a qualitative study design rooted in constructivist grounded theory methodology. The core themes identified were the impact of the pandemic on care utilization, the impact of infection control measures on provision of care, moral distress in the workplace, impact on psychological wellbeing, and adaptive strategies to help HCPs manage emotions and navigate pandemic imposed changes. This is the first Canadian study to qualitatively examine the experiences of HCPs providing care to dying patients during the COVID-19 pandemic. Implications include informing supportive strategies and shaping policies for HCPs providing palliative care. [ABSTRACT FROM AUTHOR]

Objective: To examine what factors impact college students in the United States who are deciding to initiate or continue mental health services. Participants: Spring 2021 undergraduate students (N = 453) at a large urban university. Methods: Online, cross-sectional survey with mental health service experience as the independent variable and social support, accessibility, attitudes toward mental health, mental health literacy, and trust of mental health professionals as the dependent variables, as well as thematic analysis of reasons to discontinue services. Results: Individuals with lower levels of social support and higher levels of mental health literacy were more likely to have received therapy. Participants tended to discontinue services because of negative experiences, accessibility problems, negative attitudes toward services, or they felt better. Conclusions: Mental health literacy, social support, and accessibility are significant predictors of college student service use and should be taken into consideration by university administration. [ABSTRACT FROM AUTHOR]

COVID-19 spread across the nation with Black Americans experiencing twice of the prevalence of deaths than White Americans. Black American college students are facing a unique set of biopsychosocial costs including less retention and poorer mental health. Therefore, the purpose of this study was to examine how Historically Black College or University (HBCU) students contextualize COVID-19. Interviews were conducted with 19 participants and lasted 40-60 minutes. They discussed topics including: their COVID-19 knowledge, precautionary measures, and barriers and promoters of school success were covered. Data were coded through semi-open coding and discussed among the research team. Responses were summarized by eight themes: emotional responses, colorblind rhetoric, lack of healthcare, essential work, distrust for the medical field, barriers to precautions like supply shortages and environmental factors, and poor baseline health. These findings may be used to develop interventions that moderate the impact of COVID-19 and future pandemics on mental health. [ABSTRACT FROM AUTHOR]

Objective. Health behavior research suggests that perceived social norms impact health decisions. This study aimed to (a) examine reasons for vaccine hesitancy among a sample of college students compared to a clinical sample (b) examine the accuracy of perceptions of others' receptivity and intention to seek out the COVID-19 vaccine, and (c) determine whether greater self-other normative discrepancies (SODs) were associated with increased likelihood to seek out the COVID-19 vaccine. Participants. Participants included 227 students at a Northeastern private college and 140 patients seeking medical care. Methods. College students completed an online, anonymous survey. Patients completed a paper-and-pencil survey distributed at appointment check-in. Results. Compared to their perceptions of others, participants had more positive beliefs about vaccines. The most common reason prompting individuals to seek out the vaccine was to return to "normal life." Conclusions. Future research might examine use of social norms interventions to decrease vaccine hesitancy. [ABSTRACT FROM AUTHOR]

Despite a growing need for mental health services for adolescents, treatment access among adolescents remains poor. Psychologists practicing in the United States are subject to highly variable legal standards for consent and confidentiality of minor clients, which can further suppress treatment accessibility. States permit independent consent for minors according to a wide range of criteria, but whether these criteria are empirically derived remains unknown. Inconsistencies between the law and ethical obligations for psychologists can expose minor clients to harm and force psychologists to make disclosures that violate patients' rights and ethical standards. These harms may be particularly severe for clients from vulnerable populations such as sexuality and gender diverse youth (SGDY). To prevent ethical dilemmas, psychologists and professional organizations should work toward an empirical understanding of the adolescent capacity to consent to mental health care and use that understanding to promote uniform consent and confidentiality standards. [ABSTRACT FROM AUTHOR]

Advanced care planning (ACP) utilization remains very limited in rural communities compared to urban areas. ACP earlier in the disease trajectory is particularly important for people with dementia (PWD) due to its progressive nature affecting their decision-making ability. Considering the well-documented benefits of ACP in improving the quality of end-of-life (EOL) care, the rural vs. urban disparity may indicate poorer EOL quality for rural PWD. This study aimed to explore barriers and current resources for ACP of PWD from the perspectives of health or social service providers serving rural communities. Using a qualitative approach, semi-structured face-to-face interviews were conducted with 11 health or social service professionals serving older adults and their caregivers in rural Alabama. Thematic analysis revealed three major barriers: (1) lack of knowledge, (2) psychosocial barriers, and (3) limited access to healthcare. Participants also showed misconception that a lawyer or a notary is required for ACP. Two themes arose in the participants' recommendations to address the barriers: (1) providing ACP-relevant information and (2) addressing psychosocial stressors about ACP. This study highlighted an urgent need for social policy in ACP education for caregivers and service providers in rural settings. [ABSTRACT FROM AUTHOR]