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BMC Pregnancy and Childbirth May 2024The COVID-19 pandemic has challenged the provision of maternal care. The IMAgiNE EURO study investigates the Quality of Maternal and Newborn Care during the pandemic in...
BACKGROUND
The COVID-19 pandemic has challenged the provision of maternal care. The IMAgiNE EURO study investigates the Quality of Maternal and Newborn Care during the pandemic in over 20 countries, including Switzerland.
AIM
This study aims to understand women's experiences of disrespect and abuse in Swiss health facilities during the COVID-19 pandemic.
METHODS
Data were collected via an anonymous online survey on REDCap®. Women who gave birth between March 2020 and March 2022 and answered an open-ended question in the IMAgiNE EURO questionnaire were included in the study. A qualitative thematic analysis of the women's comments was conducted using the International Confederation of Midwives' RESPECT toolkit as a framework for analysis.
FINDINGS
The data source for this study consisted of 199 comments provided by women in response to the open-ended question in the IMAgiNE EURO questionnaire. Analysis of these comments revealed clear patterns of disrespect and abuse in health facilities during the COVID-19 pandemic. These patterns include non-consensual care, with disregard for women's choices and birth preferences; undignified care, characterised by disrespectful attitudes and a lack of empathy from healthcare professionals; and feelings of abandonment and neglect, including denial of companionship during childbirth and separation from newborns. Insufficient organisational and human resources in health facilities were identified as contributing factors to disrespectful care. Empathic relationships with healthcare professionals were reported to be the cornerstone of positive experiences.
DISCUSSION
Swiss healthcare facilities showed shortcomings related to disrespect and abuse in maternal care. The pandemic context may have brought new challenges that compromised certain aspects of respectful care. The COVID-19 crisis also acted as a magnifying glass, potentially revealing and exacerbating pre-existing gaps and structural weaknesses within the healthcare system, including understaffing.
CONCLUSIONS
These findings should guide advocacy efforts, urging policy makers and health facilities to allocate adequate resources to ensure respectful and high-quality maternal care during pandemics and beyond.
Topics: Humans; COVID-19; Female; Switzerland; Adult; Pregnancy; Qualitative Research; Surveys and Questionnaires; Maternal Health Services; Attitude of Health Personnel; SARS-CoV-2; Professional-Patient Relations; Respect; Quality of Health Care
PubMed: 38822258
DOI: 10.1186/s12884-024-06598-6 -
The American Journal of Gastroenterology May 2024Insurer-mandated barriers to timely initiation of advanced therapies used to treat inflammatory bowel disease (IBD) have been shown to worsen clinical outcomes and...
Insurer-Mandated Medication Utilization Barriers are Associated With Decreased Insurance Satisfaction and Adverse Clinical Outcomes: An Inflammatory Bowel Disease Partners Survey.
INTRODUCTION
Insurer-mandated barriers to timely initiation of advanced therapies used to treat inflammatory bowel disease (IBD) have been shown to worsen clinical outcomes and increase healthcare utilization, yet rarely alter the medication ultimately prescribed.
METHODS
We conducted a survey within the IBD Partners longitudinal cohort to evaluate the frequency and patient-reported impacts of medication utilization barriers on insurance satisfaction and clinical outcomes. Barriers included medication denials, prior authorizations, and forced medication switches. Variables associated with insurance satisfaction, measured on a 1-7 Likert scale, were identified. The association between insurance-related barriers and downstream clinical outcomes (surgery, corticosteroid requirement, and disease activity) were evaluated.
RESULTS
Two thousand seventeen patients (age 45 [interquartile range 34-58] years, 73% female) were included. Seventy-two percent experienced an insurer-mandated barrier, most commonly prior authorizations (51%). Fifteen percent were denied an IBD medication by their insurer, 22% experienced an insurance-related gap in therapy, and 8% were forced by their insurer to switch from an effective medication. Insurance satisfaction was negatively associated with medication denials, prior authorization-related delays, gaps in therapy, and high-deductible health plan coverage. In the year following the initial survey, several insurance barriers were linked to negative downstream clinical outcomes, including prior authorizations associated with corticosteroid rescue (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.25-4.00), forced medication switches associated with continued disease activity (OR 3.28, 95% CI 1.56-6.89), and medication denials associated with IBD-related surgery (OR 8.92, 95% CI 1.97-40.39).
DISCUSSION
These data illustrate the frequency and negative impacts of insurer-mandated medication barriers on patients with IBD, including decreased insurance satisfaction and negative downstream clinical outcomes.
PubMed: 38819004
DOI: 10.14309/ajg.0000000000002851 -
Health Communication May 2024Despite accelerating the recovery and rehabilitation of wounded veterans and saving the U.S. substantial sums in avoided long-term care costs, military caregivers (MCs)...
Despite accelerating the recovery and rehabilitation of wounded veterans and saving the U.S. substantial sums in avoided long-term care costs, military caregivers (MCs) are an underserved community lacking resources and support. On top of managing a variety of emotional, physical, relational, and occupational challenges, MCs experience stigma. Indeed, caregiving can be a stigmatized task, especially for military-affiliated individuals who may be expected to adhere to cultural norms of personal sacrifice and resilience in the face of adversity. The current study uses narrative inquiry to better understand the unique experiences and characteristics of MCs providing care for veterans experiencing posttraumatic stress. Specifically, this study examined MCs' narratives to uncover the sociocultural experience and management of stigma related to military caregiving. Interviews with 15 military caregivers of veterans experiencing PTS demonstrated that military caregivers experienced stigma for 1) staying in the relationship, 2) enabling the veteran, 3) mismanaging the condition, and 4) flaking on plans and relationships. In response to stigma, MCs often challenged stigma through strategies of denial or evasion of responsibility. This study contributes to communication scholarship by introducing co-stigma management and further interrogating processes related to stigma management communication. In addition, the results can inform Veteran Affairs (VA) healthcare, caregiver assistance programs, health practices, and support-seeking behaviors.
PubMed: 38818796
DOI: 10.1080/10410236.2024.2360177 -
The Journal of Law, Medicine & Ethics :... 2024As a legal aid union president in New Haven, laboring within shouting distance of a different large research university, I recall how our membership rolled our eyes when...
As a legal aid union president in New Haven, laboring within shouting distance of a different large research university, I recall how our membership rolled our eyes when Professors Greiner, Pattanayak, and Hennesy of Harvard published their study providing evidence, through a randomized control trial, that law clinic housing work made no difference for clients. Representing, as I was, "lawyers, secretaries, and paralegals who have dedicated their careers to serving poor clients in crisis," the authors' conclusion generated first shock, then denial, and then an anxious realization that somebody's job was to research and disseminate such conclusions. In a 2013 United States where there was one legal aid lawyer for every 8,893 people who qualified, where federal Legal Services Corporation funding had dropped 40% over ten years in real dollars, and in an America that spends as much on Halloween costumes for its pets as it does legal aid for the poor, the inquiry felt like a pile-on. It made no more sense to us than asking if a teacher is "good for students," a nurse "good for the sick," or a chef "good for the hungry.".
Topics: Humans; Parents; Social Justice; United States
PubMed: 38818608
DOI: 10.1017/jme.2024.59 -
Health Services Management Research May 2024The sharing of information and feedback directly from service-providing staff to healthcare organisational management is vital for organisational culture and service...
The sharing of information and feedback directly from service-providing staff to healthcare organisational management is vital for organisational culture and service improvement. However, hospital doctors report feeling unable to communicate effectively with management to provide evidence and affect improvement, and this can impact job satisfaction, workplace relations, service delivery and ultimately patient safety. In this paper, we draw on data elicited from a Mobile Instant Messaging Ethnography (MIME) study involving 28 hospital doctors working in Irish hospitals, to explore the barriers preventing them from speaking up and effecting change, and the impact of this on staff morale and services. We identify three major barriers, consistent with previous literature, to effective feedback and communication: (1) organisational deafness, (2) disconnect between managers and frontline staff, and (3) denial of the narratives and issues raised. We draw these together to identify key implications from these findings for healthcare managers, and suggest policy and practice improvements.
PubMed: 38817143
DOI: 10.1177/09514848241254929 -
Eastern Mediterranean Health Journal =... May 2024The mental health of students plays a crucial role in their learning and performance. The COVID-19 pandemic, the political turmoil and a coup in Sudan has exacerbated...
BACKGROUND
The mental health of students plays a crucial role in their learning and performance. The COVID-19 pandemic, the political turmoil and a coup in Sudan has exacerbated stress and anxiety among university students in Sudan due to uncertainty about their academic activities.
AIM
To assess post-traumatic stress disorder (PTSD) occurrence and coping strategies adopted by university students in Sudan.
METHODS
This cross-sectional survey was conducted from March to June 2022. It used the Coping Orientation to Problems Experienced (Brief-COPE) and Impact of Event Scale-Revised (IES-R) questionnaires to assess the occurrence of PTSD and coping strategies among 596 university students in Sudan. Descriptive statistics were used to determine the frequency and percentage, Student's t test was used to compare the means of 2 groups and one-way analysis of variance to compare the means of ≥ 3 groups.
RESULTS
There was a high prevalence of PTSD among the students, with a score of 31.2 (SD 16.4). The total score of PTSD was higher among female students. Around 36% of the students had a PTSD score > 37, which is considered high enough to suppress immune function. The most widely adopted coping strategies were religion and acceptance of the situation, while substance use was the least. Students who had COVID-19 infection during the pandemic differed significantly from uninfected students in the application of coping strategies. In contrast, students whose family members or friends had COVID-19 were not significantly different from students with uninfected family members or friends in the application of the coping strategies, such as self-blame, denial, substance use, and behavioural disengagement.
CONCLUSION
We recommend the initiation and implementation of psychological counselling programmes for university students in Sudan onsite or remotely. Further research should be carried out to assess the long-term effects of the pandemic and the political conflicts so as to design and implement appropriate and efficient interventions.
Topics: Humans; COVID-19; Sudan; Female; Male; Students; Cross-Sectional Studies; Stress Disorders, Post-Traumatic; Universities; Adaptation, Psychological; Young Adult; Mental Health; Politics; Adult; SARS-CoV-2; Surveys and Questionnaires; Prevalence; Adolescent; Pandemics
PubMed: 38808403
DOI: 10.26719/2024.30.4.272 -
Heliyon May 2024Effective stress management after unsuccessful cardiopulmonary resuscitation (CPR) requires the determination of perceived stress and identification and reinforcement of...
BACKGROUND
Effective stress management after unsuccessful cardiopulmonary resuscitation (CPR) requires the determination of perceived stress and identification and reinforcement of effective coping strategies. Therefore, the present study was conducted to determine perceived stress and coping strategies after unsuccessful CPR for the first time among Iranian pre-hospital emergency technicians.
METHODS
A cross-sectional, descriptive, correlational, multicenter study was conducted in 2022. The research population included all pre-hospital emergency technicians working in 44 urban, road, and aerial pre-hospital emergency stations in 22 counties of Ilam Province, west of Iran. A total of 374 technicians worked in these stations, which were included in the study by census method according to the inclusion criteria. The data collection tools were the Questionnaire of perceived stress after unsuccessful CPR and Brief Coping Orientation to Problems Experienced (COPE) Inventory. The collected data were analyzed with SPSS software version 27 using descriptive and analytical statistics (Pearson correlation test, multiple linear regression analysis, independent sample T-test, and ANOVA) at a significance level of p ≤ 0.05.
RESULTS
The perceived stress was at a moderate level with a mean score of 65.56 ± 14.21. Among six coping strategies, problem-focused coping had the highest (3.01 ± 0.59) and denial had the lowest mean value (1.94 ± 0.79). Perceived stress had a significant direct relationship with 5 coping strategies, including problem-focused coping, support-focused coping, emotion-focused coping, self-distraction, and religion (p < 0.05). The strongest relationship was found between perceived stress and self-distraction followed by emotion-focused coping. According to the results of multiple regression analysis, emotion-focused coping and self-distraction had predictive roles.
CONCLUSION
The participants used different coping strategies to cope with the stress of unsuccessful CPR. The most common coping mechanisms used by the participants were problem-focused, emotion-focused, and support-focused coping. Pre-hospital emergency officials can assist pre-hospital emergency technicians in coping with occupational stress, including the stress of unsuccessful CPR, through organizing educational courses, teaching effective coping strategies, and offering support programs.
PubMed: 38803903
DOI: 10.1016/j.heliyon.2024.e31418 -
The World Allergy Organization Journal May 2024The food allergy (FA) entity went through a long difficult road which led to much delay in its recognition. After long periods of denial and misdiagnosis, it attained... (Review)
Review
The food allergy (FA) entity went through a long difficult road which led to much delay in its recognition. After long periods of denial and misdiagnosis, it attained its current designation as food hypersensitivity or allergy. This review will briefly address the evolution of the FA entity from the early BC era until our 21st century and highlight the milestones in the main aspects of diagnosis, treatment, prevention, and research. A great recognition of the allergy specialty was gained by the discovery of its main mediator -immunoglobulin E in 1967 - which also helped in classifying FA into IgE-mediated (immediate-type) and non-IgE-mediated. The cause of the increasing prevalence during the past few decades may be attributed to an increased food consumption and the consequences of modern lifestyle (the hygiene hypothesis). In addition to a skillful medical history-taking, helpful tests have been developed involving the skin or blood. The scratch test was modified to the prick test and in certain instances prick-by-prick. The use of intradermal test has been markedly reduced. Blood testing began by measuring specific-IgE antibodies (sIgE) in the serum using the radioallergosorbent test which went through multiple modifications to avoid radioisotope material and increase the test's sensitivity. The test was advanced to measure sIgE to individual allergen components. Recently, cellular tests were developed in the form of basophil activation or mast cell activation. In most cases, FA needs verification by appropriately-designed challenge testing. Regarding treatment, strict avoidance remains the basic approach. Certain food-labeling regulations led to some improvement in the problem of hidden food allergens but more is desired. Recently some protocols for oral immunotherapy (OIT) showed reasonable safety and efficacy in preventing reactions to accidental exposures. The protocol for peanut has been approved in the United States and other foods are expected to follow. Epicutaneous immunotherapy showed higher safety and promising efficacy. Sublingual immunotherapy might follow as well. Studies on the use of certain biologicals, alone or in combination of OIT, showed promising findings. Very recently, omalizumab was approved in the United States for patients with multiple FA. A major change in the strategy of prevention is the benefit of introducing allergenic foods at an early age (4-6 months). Research on FA markedly flourished in recent decades with increasing numbers of investigators, funding, publications, and education. Despite the major strides, still more awaits exploration with expected better understanding and practice of FA.
PubMed: 38800498
DOI: 10.1016/j.waojou.2024.100912 -
The British Journal of Sociology May 2024The most prominent issue influencing Turkish-Armenian relations is the international recognition of the Armenian genocide. However, there is a notable absence of...
The most prominent issue influencing Turkish-Armenian relations is the international recognition of the Armenian genocide. However, there is a notable absence of empirical analyses regarding the perceptions of the genocide among the Turkish population. This study aims to fill this scholarly gap by exploring, for the first time, the perspectives of Turkish Jews. It analyses evidence collected from interviews conducted with 14 Turkish Jews, utilising Stanley Cohen's (2001) theoretical framework, which aids in delineating significant factors by a categorisation of types of acceptance and denial. The findings highlight a diversity of responses linked to political attitudes, which can be broadly categorised into Kayades and Avlaremoz mindsets. They also show that Turkish Jews' views on the Holocaust influence how they perceive the Armenian genocide. Additionally, the results indicate that Cohen's approach is useful in explaining non-denying responses. In conclusion, the study argues that Turkish Jews' perspectives appear to be strongly related to their stance towards the Turkish state and the Holocaust.
PubMed: 38795396
DOI: 10.1111/1468-4446.13116 -
Sensors (Basel, Switzerland) May 2024The Internet of Things (IoT) and blockchain are emerging technologies that have attracted attention in many industries, including healthcare, automotive, and supply...
The Internet of Things (IoT) and blockchain are emerging technologies that have attracted attention in many industries, including healthcare, automotive, and supply chain. IoT networks and devices are typically low-powered and susceptible to cyber intrusions. However, blockchains hold considerable potential for securing low-power IoT networks. Blockchain networks provide security features such as encryption, decentralisation, time stamps, and ledger functions. The integration of blockchain and IoT technologies may address many of the security concerns. However, integrating blockchain with IoT raises several issues, including the security vulnerabilities and anomalies of blockchain-based IoT networks. In this paper, we report on our experiments using our blockchain test bed to demonstrate that blockchains on IoT platforms are vulnerable to DDoS attacks, which can also potentially lead to device hardware failures. We show that a number of anomalies are visible during either a DDoS attack or IoT device failure. In particular, the temperature of IoT hardware devices can exceed 90 °C during a DDoS attack, which could lead to hardware failure and potential fire hazards. We also found that the Block Transaction Rate (BTR) and network block loss percentage can increase due to corrupted hardware, with the BTR dropping to nearly zero blocks/sec and a block loss percentage of over 50 percent for all evaluated blockchains, and as high as 81.3 percent in one case. Our experiments demonstrate that anomalous temperature, latency, bandwidth, BTR, and network block loss percentage can potentially be used to identify DDoS attacks.
PubMed: 38793937
DOI: 10.3390/s24103083