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Nursing Open Apr 2024To construct a psychosocial intervention programme for women diagnosed with foetal anomalies based on their needs in China. (Review)
Review
AIM
To construct a psychosocial intervention programme for women diagnosed with foetal anomalies based on their needs in China.
DESIGN
A three round-modified Delphi survey from September to November 2020.
METHODS
In Round 1, based on literature review and qualitative interviews, a face-to-face meeting with eight taskforce members was conducted to generate the initial intervention indicators. In Round 2 and 3, 15 experts and three stakeholders (women undergoing termination of pregnancy for foetal anomalies) were invited by email to evaluate the importance of the indicators and built the final psychosocial intervention programme.
RESULTS
The response rate for both two rounds is 100%. The experts' authority coefficient was 0.86. The Kendall W value of the two rounds ranged between 0.191 and 0.339. A needs-based psychosocial intervention programme was established, including four periods (denial, confirmation, decision-making and recovery), three needs-based supports (information, social and acceptance commitment therapy) and 27 intervention indicators. The mean value of the importance of each index was 4.00-5.00. Further research is required to evaluate whether this programme is realistic and effective for the target audiences.
Topics: Adult; Female; Humans; Middle Aged; Pregnancy; Abortion, Induced; China; Congenital Abnormalities; Delphi Technique; Interviews as Topic; Psychiatric Nursing; Psychosocial Intervention; Surveys and Questionnaires
PubMed: 38606808
DOI: 10.1002/nop2.2164 -
Scientific Reports Apr 2024There are a series of challenges in microgrid transactions, and blockchain technology holds the promise of addressing these challenges. However, with the increasing...
There are a series of challenges in microgrid transactions, and blockchain technology holds the promise of addressing these challenges. However, with the increasing number of users in microgrid transactions, existing blockchain systems may struggle to meet the growing demands for transactions. Therefore, this paper proposes an efficient and secure blockchain consensus algorithm designed to meet the demands of large-scale microgrid electricity transactions. The algorithm begins by utilizing a Spectral clustering algorithm to partition the blockchain network into different lower-level consensus set based on the transaction characteristics of nodes. Subsequently, a dual-layer consensus process is employed to enhance the efficiency of consensus. Additionally, we have designed a secure consensus set leader election strategy to promptly identify leaders with excellent performance. Finally, we have introduced an authentication method that combines zero-knowledge proofs and key sharing to further mitigate the risk of malicious nodes participating in the consensus. Theoretical analysis indicates that our proposed consensus algorithm, incorporating multiple layers of security measures, effectively withstands blockchain attacks such as denial of service. Simulation experiment results demonstrate that our algorithm outperforms similar blockchain algorithms significantly in terms of communication overhead, consensus latency, and throughput.
PubMed: 38594352
DOI: 10.1038/s41598-024-58505-w -
Clinical Ophthalmology (Auckland, N.Z.) 2024A major barrier to glaucoma medication adherence is the patient's out-of-pocket costs. At the University of Chicago Medical Center (UCMC), the institutional pharmacy...
PURPOSE
A major barrier to glaucoma medication adherence is the patient's out-of-pocket costs. At the University of Chicago Medical Center (UCMC), the institutional pharmacy piloted a program to query out-of-pocket costs for each patient's medication list based on their insurance coverage. This study aims to describe the impact of this collaboration between the glaucoma service and the outpatient pharmacy service.
METHODS
This study is a single institution, retrospective chart review of glaucoma patients with a formulary inquiry placed by a single glaucoma specialist between 4/1/2020 and 2/28/2022. Main outcome measures included medications before and after formulary inquiries, additional steps required to access the medications (ie, formulary exceptions, prior authorizations, tier exceptions), and out-of-pocket costs.
RESULTS
A total of 343 formulary inquiries, representing 568 individual medication inquiries, were conducted. Out of the 568 medication inquiries, only 78 could be filled for an affordable price without any additional steps. For 45 inquiries, additional steps were required for the medication to become covered at an affordable price. The remaining 445 inquires required additional steps with subsequent denial or prohibitive out-of-pocket costs.
CONCLUSION
The UCMC workflow provided transparent out-of-pocket costs for patients to access glaucoma medications. This workflow may be cost-effective as it minimizes the burden on the overall system by reducing the number of patients who are unable to fill a prescription at the pharmacy due to issues with coverage or affordability. This model of physician-pharmacy collaboration can guide other institutions to implement similar workflows which directly mitigate costs and improve quality of care.
PubMed: 38584721
DOI: 10.2147/OPTH.S450629 -
Current Health Sciences Journal 2023Influenza represents a global respiratory virus infection with significant individual and societal implications, leading to considerable economic burdens and substantial...
INTRODUCTION
Influenza represents a global respiratory virus infection with significant individual and societal implications, leading to considerable economic burdens and substantial mortality rates. Vaccine hesitancy, characterized by delays or refusals despite vaccine availability, presents a growing challenge in achieving adequate vaccination rates globally.
AIM
This study aimed to assess the attitudes of Romanian general practitioners' patients toward influenza vaccination during the recommended immunization period.
MATERIALS AND METHODS
A prospective multi-centered study involving 319 patients across five Family Medicine Offices in Romania was conducted. Participants completed a 12-item Vaccination Attitudes Examination (VAX) scale, assessing factors influencing vaccine acceptance. Statistical analyses were performed to evaluate the impact of demographic variables and attitudes toward vaccination.
RESULTS
The study revealed significant variations in attitudes influencing influenza vaccine acceptance. Trust in vaccine benefits and confidence in natural immunity emerged as primary motivators for vaccine acceptance/denial, whereas concerns about commercial profiteering held lesser importance. Gender and residential environment impacted specific attitudes toward vaccination, while factors such as education and employment status did not significantly influence vaccine acceptance.
DISCUSSION
The study underscores the critical role of trust in vaccine benefits as a primary driver for vaccine acceptance, diverging from prevalent conspiracy theories. While gender and residential environment influenced attitudes toward vaccination, education and employment status did not exhibit significant correlations with vaccine acceptance.
CONCLUSIONS
Understanding public attitudes toward vaccination is crucial in designing effective public health strategies. This study emphasizes the importance of trust in vaccine benefits in driving vaccine acceptance, offering insights to enhance vaccination initiatives regionally.
PubMed: 38559830
DOI: 10.12865/CHSJ.49.04.6 -
JMIR Formative Research Mar 2024Cataract surgeries are among the most performed surgeries worldwide. A thorough patient education is essential to inform patients about the perioperative process and...
BACKGROUND
Cataract surgeries are among the most performed surgeries worldwide. A thorough patient education is essential to inform patients about the perioperative process and postoperative target results concerning the intraocular lens and objectives for visual outcomes. However, addressing all relevant aspects and questions is time-consuming. Mobile apps can facilitate this process for both patients and physicians and thus be beneficial. However, the success of such an app depends on its user friendliness and acceptance by patients.
OBJECTIVE
This study aimed to evaluate the user friendliness and acceptance of a cataract surgery education app on mobile devices among patients undergoing cataract surgery, the characteristics of patients who benefit the most from app use, and the influence of the app on patient satisfaction with treatment.
METHODS
All patients who underwent cataract surgery at an ophthalmological practice from August 2020 to July 2021 were invited to participate in this randomized controlled trial. Out of 493 invited patients, 297 (60.2%) were enrolled in this study. Patients were randomized into 3 different groups. Half of the patients were offered to participate in Group 1 with use of the "Patient Journey" app. However, if they decided not to use the app, they were included in Group 2 (app denial). The other half of the patients were included in Group 3 (control) with no use of the app and with information provided conventionally. The app provided general information on the ophthalmological center, surgeons, cataract, and treatment options. Different questionnaires were used in all 3 groups to evaluate satisfaction with the perioperative process. Group 1 evaluated the app. Demographic characteristics, such as age, gender, and educational degree, were assessed.
RESULTS
Group 1 included 77 patients (median age 69 years). Group 2 included 61 patients, and their median age was higher (median age 79 years). Group 3 included 159 patients (median age 74 years). There was no difference in satisfaction with the perioperative process and clinic between the 3 groups. Almost all app users appreciated the digital details provided for the organization and the information on the surgery. Age did not play a major role in appreciation of the app. Female patients tended to appreciate the information provided more than male patients. Patients who did not have a higher university degree experienced more benefits from the informational content of the app and were the most satisfied with the information. However, male patients and academics were in general more aware of technology and handled the app more easily.
CONCLUSIONS
The app showed high user friendliness and acceptance, and could particularly benefit specific patient groups. App users demonstrated a noninferior high satisfaction with the treatment in the ophthalmological center in comparison with patients who were informed about the surgery only conventionally.
PubMed: 38551619
DOI: 10.2196/55742 -
Mathematical Biosciences and... Feb 2024Low rate distributed denial of service attack (LR-DDoS) is a special type of distributed denial of service (DDoS) attack, which uses the vulnerability of HTTP protocol...
Low rate distributed denial of service attack (LR-DDoS) is a special type of distributed denial of service (DDoS) attack, which uses the vulnerability of HTTP protocol to send HTTP requests to applications or servers at a slow speed, resulting in long-term occupation of server threads and affecting the normal access of legitimate users. Since LR-DDoS attacks do not need to send flooding or a large number of HTTP requests, it is difficult for traditional intrusion detection methods to detect such attacks, especially when HTTP traffic is encrypted. To overcome the above problems, we proposed an encrypted LR-DDoS attack detection and mitigation method based on the multi-granularity feature fusion (MFFLR-DDoS) for software defined networking (SDN). This method analyzes the encrypted session flow from the time sequence of packets and the spatiality of session flow and uses different deep learning methods to extract features, to obtain more effective features for abnormal traffic detection. In addition, we used the advantages of SDN architecture to perform real-time defense against LR-DDoS attacks by the way of SDN controller issuing flow rules. The experimental results showed that the MFFLR-DDoS model had a higher detection rate than advanced methods, and could mitigate LR-DDoS attack traffic online and in real-time.
PubMed: 38549324
DOI: 10.3934/mbe.2024185 -
Harm Reduction Journal Mar 2024People who use drugs experience pain at two to three times the rate of the general population and yet continue to face substantial barriers to accessing appropriate and...
BACKGROUND
People who use drugs experience pain at two to three times the rate of the general population and yet continue to face substantial barriers to accessing appropriate and adequate treatment for pain. In light of the overdose crisis and revised opioid prescribing guidelines, we sought to identify factors associated with being denied pain medication and longitudinally investigate denial rates among people who use drugs.
METHODS
We used multivariable generalized estimating equations analyses to investigate factors associated with being denied pain medication among people who use drugs reporting pain in three prospective cohort studies in Vancouver, Canada. Analyses were restricted to study periods in which participants requested a prescription for pain from a healthcare provider. Descriptive statistics detail denial rates and actions taken by participants after being denied.
RESULTS
Among 1168 participants who requested a prescription for pain between December 2012 and March 2020, the median age was 47 years and 63.0% were male. Among 4,179 six-month observation periods, 907 (21.7%) included a report of being denied requested pain medication. In multivariable analyses, age was negatively associated with prescription denial (adjusted odds ratio [AOR] = 0.98, 95% confidence interval [CI]:0.97-0.99), while self-managing pain (AOR = 2.48, 95%CI:2.04-3.00), experiencing a non-fatal overdose (AOR = 1.51, 95%CI:1.22-1.88), engagement in opioid agonist therapy (AOR = 1.32, 95%CI:1.09-1.61), and daily use of heroin or other unregulated opioids (AOR = 1.32, 95%CI:1.05-1.66) were positively associated with being denied. Common actions taken (n = 895) after denial were accessing the unregulated drug supply (53.5%), doing nothing (30.6%), and going to a different doctor/emergency room (6.1%). The period following the introduction of new prescribing guidelines was not associated with a change in denial rates.
CONCLUSIONS
A substantial proportion of people who use drugs continue to be denied prescriptions for pain, with such denial associated with important substance use-related harms, including non-fatal overdose. Guidelines specific to the pharmaceutical management of pain among people who use drugs are needed.
Topics: Humans; Male; Middle Aged; Female; Analgesics, Opioid; Prospective Studies; Practice Patterns, Physicians'; Canada; Drug Overdose; Pain; Prescription Drugs; Prescriptions
PubMed: 38549113
DOI: 10.1186/s12954-024-00956-5 -
Journal of Education and Health... 2024If in the past the relationship between caregiver and patient was paternalistic based on the principle of protection, the advent of health democracy has made this...
BACKGROUND
If in the past the relationship between caregiver and patient was paternalistic based on the principle of protection, the advent of health democracy has made this relationship evolve to build it on the principles of equality and autonomy for the patient. However, this practice leaves something to be desired, given the forms of inequality in access to information that mark the relationship between caregiver and cancer patient.
MATERIALS AND METHODS
The objective of this qualitative study is to present a sociological view of the process of shaping inequalities in access to information and its determinants. The study took place in the medical prefecture of Meknes, with a target population consisting of cancer patients treated in public and private health establishments. A qualitative content analysis approach using semi-structured interviews was employed.
RESULT
A diversity of attitudes of the cancer patient with regard to the information, depending on whether the patient is strongly or weakly involved by the health professional in his or her illness or in the care he or she receives. In this case: a) active patient better informed; b) passive patient more or less informed; c) patient in denial who refuses to be informed.
CONCLUSION
It seems that the issue of inequality of access to information is not a topical one, and yet it is given little consideration in the policies of the Ministry of Health, particularly in the fight against cancer in Morocco.
PubMed: 38545307
DOI: 10.4103/jehp.jehp_1620_22 -
Brain Sciences Mar 2024One significant obstacle to gaining a widespread awareness of the ongoing climate change is the nature of its manifestations in relation to our perception: climate...
One significant obstacle to gaining a widespread awareness of the ongoing climate change is the nature of its manifestations in relation to our perception: climate change effects are gradual, distributed, and sometimes seemingly contradictory. These features result in a lag in collective climate action and sometimes foster climate skepticism and climate denial. While the literature on climate change perception and belief has thoroughly explored its sociocultural and sociopolitical aspects, research on the potential contribution of psychophysiological factors remains scarce. In this perspective paper, we outline evidence and arguments for the involvement of psychophysiological systems such as thermoception, hygroreception, and interoception in modulating climate change awareness. We discuss psychophysiological mechanisms of climate change awareness in animals and humans, as well as possible sources of individual variance in climate change perception. We conclude by suggesting novel research questions which would be worthwhile to pursue in future studies.
PubMed: 38539654
DOI: 10.3390/brainsci14030266 -
Frontiers in Sociology 2024Just like an army of ants caught in an ant mill, individuals, groups and even whole societies are sometimes caught up in a Death Spiral, a vicious cycle of... (Review)
Review
Just like an army of ants caught in an ant mill, individuals, groups and even whole societies are sometimes caught up in a Death Spiral, a vicious cycle of self-reinforcing dysfunctional behavior characterized by continuous flawed decision making, myopic single-minded focus on one (set of) solution(s), denial, distrust, micromanagement, dogmatic thinking and learned helplessness. We propose the term to describe this difficult-to-break downward spiral of societal decline. Specifically, in the current theory-building review we aim to: (a) more clearly define and describe the Death Spiral Effect; (b) model the downward spiral of societal decline as well as an upward spiral; (c) describe how and why individuals, groups and even society at large might be caught up in a Death Spiral; and (d) offer a positive way forward in terms of evidence-based solutions to escape the Death Spiral Effect. Management theory hints on the occurrence of this phenomenon and offers as solution. On a societal level may be important. Prior research indicates that historically, two key factors trigger this type of societal decline: creating an upper layer of elites and a lower layer of masses; and . Historical key markers of societal decline are a steep increase in inequalities, government overreach, over-integration (interdependencies in networks) and a rapidly decreasing trust in institutions and resulting collapse of legitimacy. Important issues that we aim to shed light on are the behavioral underpinnings of decline, as well as the question if and how societal decline can be reversed. We explore the extension of these theories from the company/organization level to the society level, and make use of insights from both micro-, meso-, and macro-level theories (e.g., Complex Adaptive Systems and collapsology, the study of the risks of collapse of industrial civilization) to explain this process of societal demise. Our review furthermore draws on theories such as Social Safety Theory, Conservation of Resources Theory, and management theories that describe the decline and fall of groups, companies and societies, as well as offer ways to reverse this trend.
PubMed: 38533441
DOI: 10.3389/fsoc.2024.1194597