Abstract: Background Among individuals with heart failure (HF), racial differences in comorbidities may be mediated by social determinants of health (SDOH). Methods Black and White US community-dwelling participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study aged ≥ 45 years with an adjudicated HF hospitalization between 2003 and 2017 were included in this cross-sectional analysis. We assessed whether higher prevalence of comorbidities in Black participants compared to White participants were mediated by SDOH in socioeconomic, environment/housing, social support, and healthcare access domains, using the inverse odds weighting method. Results Black (n = 240) compared to White (n = 293) participants with HF with preserved ejection fraction (HFpEF) had higher prevalence of diabetes [1.38 (95% CI 1.18–1.61)], chronic kidney disease [1.21 (95% CI 1.01–1.45)], and anemia [1.33 (95% CI 1.02–1.75)] and lower prevalence of atrial fibrillation [0.80 (95% CI (0.65–0.98)]. Black (n = 314) compared to White (n = 367) participants with HF with reduced ejection fraction (HFrEF) had higher prevalence of hypertension [1.04 (95% CI 1.02–1.07)] and diabetes [1.26 (95% CI 1.09–1.45)] and lower prevalence of coronary artery disease [0.86 (95% CI 0.78–0.94)] and atrial fibrillation [0.70 (95% CI 0.58–0.83)]. Socioeconomic status explained 14.5%, 26.5% and 40% of excess diabetes, anemia, and chronic kidney disease among Black adults with HFpEF; however; mediation was not statistically significant and no other SDOH substantially mediated differences in comorbidity prevalence. Conclusions Socioeconomic status partially mediated excess diabetes, anemia, and chronic kidney disease experienced by Black adults with HFpEF, but differences in other comorbidities were not explained by other SDOH examined. PubDate: 2024-08-06
Abstract: Background Lung cancer is a major cause of health loss internationally, and in Australia. Most of that loss is inequitably concentrated among vulnerable or disadvantaged people and amenable to prevention and earlier detection. In response, best practice lung cancer care considers peoples’ background, circumstances and care needs. Comprehensive, person level descriptions of demographic, health and discrete socio-economic disadvantage related factors are therefore required to inform best practice. We examine population wide correlations of demographic, health and socioeconomic characteristics with lung cancer diagnosis for use in cancer control programs, including screening. Methods A study of 5,504,777 (89.9%) adults living in New South Wales and participating in Australia’s Census in August 2016 with subsequent follow-up to the end of 2018. The Australian Bureau of Statistics’ (ABS) person-level integrated data asset linked census records with the NSW population cancer registry which includes primary site. Our study compared census participants who did not experience cancer in the follow-up period with those diagnosed with lung cancer, (n = 6160 and ICD10 C33-34). Outcomes are expressed as the adjusted relative odds (aOR) of incident lung cancer among adults in the community and measured using multi-variable logistic regression models. Validated ABS methods informed categorisation of social and economic variables. Results Multivariable comparison of those with lung cancer and those without a first cancer diagnosis (3276 lung cancers among 2,484,145 males; 2884 lung cancers among 2,944,148 females) showed associations with increasing age, varying ancestry, living alone (aOR = 1.30 95% CI 1.19–1.42 males; 1.24 95% CI 1.14–1.35 females), number of health conditions medicated, less than Year 12 education (aOR = 1.40 95% CI 1.30–1.51 males; 1.37 95% CI 1.27–1.48 females) and housing authority rental (aOR = 1.69 95% CI 1.48–1.94 males; 1.85 95% CI 1.63–2.11 females). Additional associations occurred among males with low income, disabilities before age 70, those unemployed and labouring occupations. As numbers of characteristics increased, so did the likelihood of lung cancer. Conclusion We provided a population wide description of characteristics relevant to lung cancer diagnosis. Deeper knowledge of these characteristics inform continuing development of lung cancer programs in prevention (e.g. tobacco control) and detection (e.g. lung cancer screening), then help prioritise targeted delivery of those programs. PubDate: 2024-07-26
Abstract: Objectives Non-communicable diseases (NCDs) account for over 30% of disability-adjusted life years in South Africa. In this research, we offer an estimate of the potential reduction in NCD incidence that would arise from an improvement in diet, combined with a reduction in both tobacco and alcohol consumption. Methods We apply the PRIME model, which simulates the effect of risk reduction on NCD incidence. The model inputs baseline data related to the population, risky consumption behaviour and NCD incidence. The model allows for counterfactual scenarios altering the risky consumption behaviour to yield revised NCD incidence. Results We find that reducing salt, tobacco and alcohol, along with improved fruit, vegetable and fiber consumption would yield a 10% reduction in NCDs from the 2018 baseline. NCD incidence reductions arise primarily from ischemic heart disease (49%), cerebrovascular diseases (33%) and bronchus and lung disease (11%). Conclusion South Africa’s NCD incidence is high because of relatively poor behavioural choices, despite plans and policies aimed at changing this. South Africa should increase their efforts to reach NCD goals. If the government is able to reduce harmful behaviour, with respect to a number of the underlying consumption choices, NCD incidence is expected to fall precipitously. PubDate: 2024-07-23
Abstract: Purpose During the COVID-19 pandemic, the NZ COVID Tracer App (NZCTA) was released as a digital intervention to support contact tracing processes in Aotearoa New Zealand. This paper examines whether NZCTA met the data governance requirements of the Indigenous Māori people. Māori are an interesting case study as they have unique Treaty and data sovereignty rights, and a higher risk of COVID-related mortality. Methods The NZCTA was assessed against 24 criteria drawn from the Māori Data Governance Model. The assessment drew on documentary sources and the authors’ knowledge of NZCTA and contact tracing process. Each criteria was assessed as ‘met’, ‘partially met’ or ‘not met’. Results Our retrospective assessment showed a mixed performance against the Māori Data Governance Model, with NZCTA only fulfilling seven of the 24 model criteria and failing to meet nine. Conclusion There is significant room for improvement in future digital health interventions for Māori. Much work remains to be done in the Aotearoa public sector to uphold Māori data sovereignty and address systemic barriers to genuine partnership with Māori. PubDate: 2024-07-16
Abstract: Background The St. George’s Respiratory Questionnaire (SGRQ) and its idiopathic pulmonary fibrosis (IPF) version (SGRQ-I) are widely used to assess health-related quality of life in IPF. However, the psychometric properties of these questionnaires in the IPF population have not been thoroughly evaluated. This systematic review assessed and summarized the available evidence on the psychometric properties of the SGRQ and SGRQ-I in IPF patients. Methods Seven electronic databases were searched to identify relevant studies. The eligibility criteria included full-text studies focusing on the psychometric properties of the SGRQ and SGRQ-I in patients with IPF. The risk of bias, criteria for good measurement properties, and strength of evidence were assessed based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The inverse-variance heterogeneity (IVhet) model was used to pool results for construct validity. Results A total of 24 studies were included; 19 assessed the psychometric properties of the SGRQ, and seven evaluated the SGRQ-I. Structural validity was assessed in one study for the SGRQ-I. Most domains of the SGRQ and SGRQ-I, except for the symptom domain of the SGRQ, had acceptable internal consistency. Both questionnaires demonstrated adequate test–retest reliability, known-groups validity, and responsiveness. Regarding construct validity, there were moderate to strong correlations with respiratory-specific measures, yet weaker correlations were observed with pulmonary function tests. Interpretability analysis revealed minor floor and ceiling effects. Conclusion The SGRQ and SGRQ-I have the potential to capture essential dimensions of health-related quality of life (HRQoL) in IPF. However, further research should focus on ensuring that the items and domains of these questionnaires truly reflect the unique challenges and experiences faced by patients with IPF through content validity studies. PubDate: 2024-07-02
Abstract: Objective To understand how diabetes mellitus (DM) diagnosed at different ages of adulthood are associated with various incident subsequent non-communicable diseases (NCDs). Methods We performed a nationwide population-based analysis comparing 212 participants first diagnosed with DM at 20–39, 40–49, 50–59, or 60–69 years of age, with 17,541 participants without DM history, using data from the Indonesian Family Life Survey. Subsequent NCDs that were examined included hypertension, lung diseases, heart diseases, arthritis, liver diseases, kidney diseases, and digestive diseases. We estimated weighted risk ratios and 95% confidence intervals using Poisson regression, adjusting for age, sex, urbanicity, and tobacco use history. Results Those diagnosed with DM in all age groups had significantly higher risk of hypertension, compared with those without DM history. Compared with those without DM history, younger individuals with DM diagnosed at 20–39 years of age had significantly higher risks of lung diseases and arthritis, and those with DM diagnosed at 20–49 years of age had significantly higher risk of digestive diseases. Older individuals with DM diagnosed at 40–69 years of age had significantly higher risk of liver diseases, and those with DM diagnosed at 40–59 years of age had significantly higher risk of heart diseases, compared with those without DM history. Participants with DM were diagnosed with subsequent NCDs at younger ages compared with those without DM history. Conclusion Our findings contribute to health surveillance and may promote beneficial lifestyle changes in those with early-onset and later-onset DM, which can help prevent subsequent NCDs and improve public health. PubDate: 2024-06-27
Abstract: Abstract This study underscores the distinctive role of occupational therapy in advancing the health and wellbeing of forcibly displaced individuals (FDIs), who often encounter contextual and systemic barriers and medical complications that prevent them from engaging in daily tasks. These injustices can be mitigated through health promotion and prevention strategies that aim to enhance participation in daily life activities. There has been limited research in low- to middle-income countries (LMICs) in relation to occupational therapy services for FDIs despite most FDIs originating from LMICs. To address this gap, this study adopted Arksey and O’Malley’s framework for a scoping review to consolidate existing knowledge on the occupational therapy health promotion and prevention of disease and disability services for FDIs in LMICs. Searches were conducted on six online databases. Six studies aligned with the inclusion criteria. Findings revealed that most occupational therapy services are directed towards refugees in Jordan, which contains one of the largest refugee camps. FDIs from Africa and internally displaced people receive the least number of interventions. The occupational therapy services outlined in the six sources primarily consist of health education talks, early childhood interventions, and health promotion activities centred around various occupations such as work and sports groups. Recommendations for policy guidelines include incorporating occupational therapy services within the stipulated FDI services. Our approach aims to situate the contribution of occupational therapy health promotion and prevention of disease and disability services within the broader context of FDIs’ overall health and wellbeing. PubDate: 2024-06-13 DOI: 10.1007/s44155-024-00088-y
Abstract: Aim Families from socioeconomically deprived backgrounds appear to have been greatly impacted and face worsening inequalities as a result of the COVID-19 pandemic. With more than half of children in Newham, East London, living in poverty, this study aimed to investigate the impact of the COVID-19 lockdowns on families with a child under 5 years-old in Newham and identify their immediate needs to inform recovery efforts. Subjects and methods This was a qualitative study. Semi-structured interviews were conducted with 13 participants (2 fathers; 11 mothers) exploring the impact of the COVID-19 lockdowns on family life, neighbourhood and community and important relationships in the child’s world. Results All parents experienced significant impacts on family life and well-being because of the pandemic. Families were placed under increased stress and were concerned about the impacts on child development. Low-income families were most disadvantaged, experiencing lack of professional support, community engagement and inadequate housing. Conclusion Families were placed under increasing pressure during the pandemic and recovery efforts need to target those most affected, such as families from low-income households. Recovery efforts should target child social and language development, family mental health, professional service engagement and community involvement. PubDate: 2024-06-06 DOI: 10.1007/s44155-024-00082-4
Abstract: Purpose The purpose of this study was to explore the role of self-directed ageism in the relationship between frailty and quality of life in community-dwelling older adults. Methods Secondary data-analysis on data from the Belgian Ageing Studies. A stratified sample of 1895 participants, based on census data by gender and age, was drawn between 2017 and 2019. Frailty, quality of life and self-directed ageism were assessed by the Comprehensive Frailty Assessment Instrument, a numeric rating scale and a newly developed self-directed ageism scale, respectively. The validity of this new scale was assessed by exploratory factor analysis, while mediation analysis was used to explore if self-directed ageism mediates the relationship between frailty and quality of life. Results The self-directed ageism scale proved highly reliable (Cronbach’s α = 0.898, Spearman-Brown = 0.906), explaining 58.86% of the variance in self-directed ageism. Respondents scored an average of 23.6 on 40 for self-directed ageism, 26.94 on 100 for frailty, and a median of 8 on 10 for quality of life. Mediation analysis showed that frailty negatively correlates with quality of life, and that this relationship is partially mediated by self-directed ageism. Conclusion Most respondents were identified as mild frail, experienced self-directed ageism, and those 80 or older rated their quality of life lower. The present study showed that frailty negatively correlates with quality of life and this relationship is partially mediated by self-directed ageism. We conclude that every effort should be made to prevent frailty, ageism and self-directed ageism as they impact community-dwelling older people’s quality of life. PubDate: 2024-05-30 DOI: 10.1007/s44155-024-00087-z
Abstract: Background Quality of Life (QoL) is an individual’s subjective perception of well-being within their cultural context. While most QoL studies focus on individuals with certain health conditions, factors such as sex, marital status, education, and family structure can influence QoL beyond age and health conditions. Considering the limited studies on QoL in the general Indian population, especially from rural areas, the present study aims to explore the QoL and sociodemographic factors affecting QoL among community-dwelling adults in rural Punjab. Methods This community-based cross-sectional study was conducted among 931 individuals of both sexes (59.6% female) aged 20–75 years residing in rural areas of Mansa, Punjab, India. Sociodemographic data were collected using an interview schedule, and QoL was measured using the WHOQOL-BREF. Results The overall mean QoL score was found to be 67.44 ± 14.7. The most affected QoL was in the physical domain (mean = 60.203 ± 13.49), followed by psychological (mean = 65.67 ± 18.3), social-relationship (mean = 69.88 ± 26.43), and environmental domains (mean = 74.05 ± 20.58). Adjusted logistic regression analysis revealed female sex, advanced age (age group ≥ 60 years), illiteracy, and unmarried status to be positively associated and family size of 6–10 members to be negatively associated with poor QoL. Conclusion The study suggests that females, elderlies, illiterates, and unmarried individuals may be at a higher risk of poor QoL. Further, education and a bigger family size appear to increase subjective well-being among participants. PubDate: 2024-05-28 DOI: 10.1007/s44155-024-00085-1
Abstract: Abstract Although patients experiencing food insecurity commonly screen positive for a myriad of social determinants of health (SDOH) needs and chronic medical conditions influenced by diet, few studies have investigated associations within both uninsured and food insecure populations. We screened patients for food insecurity using the USDA six-item short form between October 2021 and April 2022. We then evaluated associations of food security status with nine separate SDOH needs and eight chronic medical conditions. In this cross-sectional study, of the 190 patients seen at a student-run free clinic serving patients without health insurance, 135 (71%) completed the SDOH survey. We identified chronic medical conditions via retrospective chart review and analyzed associations using multivariable logistic regressions adjusted for age and sex. Uninsured participants experiencing food insecurity (n = 22,16.3%) requested more support for: medications (adjusted odds ratio [AOR] = 7.28; 95% Confidence Interval [95% CI] = 2.33–23.2); p-value [P] = < 0.001, housing (AOR = 9.99; 95% CI = 2.29–48.7; P = 0.002), utilities (AOR = 3.94; 95% CI = 1.07–13.5; P = 0.03), mental health resources (AOR = 4.54; 95% CI = 1.66–12.5; P = 0.003), health insurance (AOR = 2.86; 95% CI = 1.09–8.22; P = 0.04), and dental care (AOR = 3.65; 95% CI = 1.26–13.3; P = 0.03). These participants were more likely to have anxiety (AOR = 3.26; 95% CI = 1.23–8.38; P = 0.02) and depression (AOR = 2.88; 95% CI = 1.01–7.80; P = 0.04) diagnoses or symptoms. We also discovered that individuals aged 18–50 experiencing food insecurity had a higher number of health conditions (AOR = 6.3455; 95% CI = 1.49–26.99; P = 0.01), underscoring the profound impact of SDOH in younger populations. Understanding the interplay between food insecurity, SDOH needs, and medical conditions informs interventions, including food distribution programs and enhanced mental health resources. PubDate: 2024-05-18 DOI: 10.1007/s44155-024-00084-2
Abstract: Introduction To mitigate the impact of the COVID-19 pandemic, face mask use has been a key component of public health measures. Research in most settings has focused on understanding the effectiveness of this intervention in reducing COVID-19 transmission. This study aimed to identify the barriers and motivators of face mask use in the Zimbabwean population. Methods Thirty key informant interviews (KIIs) and 10 focus group discussions (FGDs) were conducted with homogenous study groups of health workers, village health workers, church leaders, traditional healers, teachers, women leaders, transporters, youth leaders and the general population selected in 10 districts across the country from September–October 2022. Each study group consisted of key informants and FGD participants. Interviews and FGDs were captured using digital recording devices, transcribed verbatim, and translated into English. The data were analysed manually via thematic analysis. Findings Six themes were generated in this study. The four themes identified as barriers were individual factors (low risk perception in rural areas and as the number of cases declined due to vaccination, lack of conviction and lack of knowledge on the importance of face masking resulting in practices such as sharing and improper wearing of masks), access challenges (due to scarcity and affordability resulting in reusing dirty masks or washing surgical masks), concern about side effects (breathing difficulties and other respiratory complications), and sociocultural and religious beliefs (resulting in removal of masks by traditional healers during consultations, removal of masks in church). Two themes that were identified as motivators included perceived benefits (confidence in the effectiveness of facemasks for the prevention of COVID-19 transmission) and environmental factors (fear of law enforcement agents and village health workers). Conclusions The study findings underscore the need of awareness campaigns, improvement of accessibility and affordability of masks, sensitivity to religious and cultural beliefs to increase the usage and effectiveness of face mask during pandemics of respiratory diseases. PubDate: 2024-05-16 DOI: 10.1007/s44155-024-00083-3
Abstract: Abstract Unhealthy behaviors such as poor diet and tobacco use contribute to disease burden and escalating healthcare costs. This paper evaluates potential savings from people adopting reduced risk behaviors in Mexico. Using the Preventable Risk Integrated Model, we compare actual consumption in 2016 (baseline) to optimal intake following WHO guidelines (counterfactual) for salt, fiber, fruit/vegetables, and fat to estimate reductions in coronary, cerebrovascular, cancer, diabetes and hypertensive diseases. We also model 50% of smokers switching to e-cigarettes/heated tobacco with 65–97% lower disease risk. Results indicate over 650,000 preventable cases annually, mostly from diet changes (fruits/vegetables, fat, salt). Healthcare cost savings reach $3.4 billion USD; $2.8 billion from nutrition and $0.3 billion from smoking substitution. Fruit/vegetable intake and reduced fat confer over $1 billion savings each. Salt and fiber also contribute significantly. Adding smoking transitions provides further savings. Shifting Mexicans towards healthier diets and alternative nicotine products could substantially lower disease burden and healthcare costs. These findings underscore the economic imperative of promoting reduced-risk behaviors through public health policies. PubDate: 2024-05-15 DOI: 10.1007/s44155-024-00079-z
Abstract: Purpose To explore the epidemiology and demographic risk factors for myopia among a clinical sample. Methods In a hospital-based retrospective study, eligible subjects were grouped into either myopia or non-myopia. Demographic data, including age, sex, occupation, area of residence, region of residence, and ethnicity, were analysed. Other clinical information analysed included the degree of myopia and intervention provided for the myopia. Results Overall, the medical records of 15807 patients were retrieved between January 2015 and December 2019, with 50.9% being males. The mean ± SD age of the patients was 42.81 ± 18.99 years. A total of 44.4% of the patients were myopic. Age, type of ethnic group, occupation, and area of residence were associated with myopia. Demographic risk factors for myopia included occupations such as professionals (OR: 2.93; 95% CI 2.44–3.52), technicians and associated workers (OR: 6.71; 95% CI 5.15–8.74), service workers (OR: 11.74; 95% CI 9.62–14.33), skilled agriculture and fishery (OR: 1.88; 95% CI 1.41–2.50), craft workers (OR: 3.41; 95% CI 2.75–4.25), armed forces (OR: 10.26; 95% CI 7.54–13.97), students (OR: 3.49; 95% CI 2.76–4.42), the unemployed (OR: 6.64; 95% CI 5.44–8.11), as well as Ewe (OR: 1.46; 95% CI 1.17–1.82) and Ga-Adangbe (OR: 1.28; 95% CI 1.05–1.54) ethnicities. Conclusion Ewe and Ga-Adangbe ethnicities, and specific occupations are risk factors for myopia. PubDate: 2024-05-13 DOI: 10.1007/s44155-024-00081-5
Abstract: Abstract Exit is not an easy task for a sex worker. Academic investigations of the reasons and barriers to exit from the sex industry are lacking heavily. Sex work is a stigmatised profession, even though the workers find it difficult to exit the same. The current study attempted to understand the barriers faced by female sex workers in Puducherry, a union territory in the southeast part of India, to exit from sex work. The participants comprise 19 female sex workers (FSW) who work in Puducherry. The data were collected through in-depth interviews. All of the participants had thoughts about quitting. The barriers to exit were identified. The barriers were recognised at the individual, interpersonal (microsystem), and structural (macro system) levels within the framework of Bronfenbrenner’s Ecological Systems Theory, which are discussed in detail in the paper. The study also identified a lack of support systems for the targeted population. PubDate: 2024-04-26 DOI: 10.1007/s44155-024-00080-6
Abstract: Abstract By investigating the role of religiosity in shaping Human Well-being, this study bridges the gap through quantitative study on the importance of religious capital to enhance people’s level of well-being. This research emphasized the relation of social exclusion and religious capital to wellbeing, whereas previous studies generally used individual and economic factors as the basis. Due to large sample size of 757 people, this quantitative research using Divine Economic Survey 2013 data looks at how religious capital affects people's subjective well-being. To minimize the diversity of subjective well-being, prayers, and religious activities, constructing them continuous and escaping the problem of multicollinearity and emphasizing the key underlying factors that most effectively capture the variance in these variables, therefore we have adopted principal component analysis. The ordinary least squares approach is then used to regress the variables and evaluate the links between subjective wellbeing and rituals, religious practices, gender health, general education. household size, and marital status of individuals. The finding reveals that religious rituals, gender, age, general education, health, and log of income are statistically significant and have a positive influence on subjective well-being, but Household Members and Marital Status are statistically significant and negatively affect the subjective well-being of human-being. The study is beneficial for government agencies that would make the policies and programs to augment people’s income, educational prospects and health facilities and services. PubDate: 2024-04-11 DOI: 10.1007/s44155-024-00067-3
Abstract: Abstract The study aim was to analyse the differences in work-life balance between and within genders (1159 women, 1077 men, and 5 trans*), and their effects on health outcomes, according to housing insecurity, and social class. We measured five health outcomes: mental health, self-perceived health, sleep quality, chronic headaches, and chronic backpain. The explanatory variables were productive, reproductive workloads, and their interactions. Among women with housing insecurity, those with no productive workload and moderate reproductive workload had the poorest mental health, self-perceived health, and sleep quality. Among women without housing insecurity of non-manual social class, those with productive workload and high reproductive workload had the poorest mental health and sleep quality. Among men with housing insecurity, those with no productive workload and high reproductive workload had the poorest sleep quality and chronic backpain. The health effects of the work-life balance are not the same for all people and vary according to housing situation, social class, and gender. PubDate: 2024-04-09 DOI: 10.1007/s44155-024-00077-1
Abstract: Background The reproductive years provide a window into future risk for Type 2 Diabetes (T2DM); women’s risk is seven to 10 times higher after gestational diabetes (GDM) and two to four times higher after a hypertensive disorder of pregnancy (HDP). Targeting reproductive-aged women at high risk for T2DM could reduce future incidence. However, little is known about such women’s diabetes risk perceptions, barriers to/motivators of lifestyle change or their knowledge about lifestyle change—information essential to understanding how to engage these at-risk women in tailored prevention programs promoting long-term health. This study’s aims were to describe: among reproductive-aged women at high risk for T2DM, what is/are (1) personal health-risk awareness, (2) lifestyle-change interest, and (3) barriers to/motivators of participation in lifestyle-change programs' Methods Women aged 18 and older were eligible if they had one of the following health risks: (1) GDM or HDP during pregnancy, (2) prediabetes diagnosis, or (3) BMI classified as obese. Three Zoom focus groups, organized by risk group, were conducted with a total of 20 participants. Qualitative content and thematic analysis were used for the focus-group transcriptions. Results Women’s personal health-risk awareness was limited and generalized (e.g., being overweight might lead to other risks) and rarely reflected awareness connected to their personal health history (e.g., GDM increases their lifetime risk of T2DM). Participants had at least one of the outlined eligibility health risks (e.g., GDM, prediabetes); they did not believe their healthcare providers sufficiently followed or addressed those risks. All women expressed interest in making healthy-lifestyle changes, including engagement in formal programs, but they identified multiple barriers to healthy-behavior change related to being “busy moms.” Women emphasized the need for social support and realistic solutions that accounted for the dynamics of motherhood and family life. Common motivators included the desire to maintain health for their families and to set a good example for their children. Conclusions Participants lacked knowledge and were eager for information. Healthcare improvement opportunities include better coordination of care between primary and specialty-care providers, and more frequent communication and education on diabetes-related health risks and long-term health. Formal lifestyle programs should tailor content by providing multiple formats and flexibility of scheduling while leveraging peer support for sustained engagement. PubDate: 2024-04-09 DOI: 10.1007/s44155-024-00078-0
Abstract: Background The relationship between severe mental illness and risky sexual behaviors, defined as acts associated with a higher risk level is notably significant in sub-Saharan Africa. In Uganda, mental disorders have been substantially correlated with unsafe sexual practices, contributing to the global burden of risky sexual behaviors. The consequential outcomes, such as sexually transmitted diseases, has resulted into a significant challenge in managing severe mental illness and potentially increased risky sexual behaviour. There is an urgent need to identify and understand factors specific to Uganda that amplify the vulnerability of severe mental illness patients to risky sexual behaviors. This study aimed to understand the vulnerability factors to risky sexual behaviour in severe mental illness in central and south-western Uganda, seeking to inform the development of tailored and effective intervention strategies to address this critical issue. Methods This was a qualitative descriptive study that was carried out at Butabika and Masaka hospitals in Uganda, involving a varied group of 32 individuals, comprising 12 persons with diagnosed Severe Mental Illness (Schizophrenia, Bipolar Affective Disorder, or Recurrent Major Depressive Disorder) and to risky sexual behaviors, 8 caregivers (who had patients with severe mental illness and to risky sexual behaviors) and 12 mental health specialists, (who had treated these participants). Purposive sampling was done by intentionally selecting participants based on specific attributes relevant to the research question and the objective of the study which was to explore the factors contributing vulnerability to risky sexual behaviour in severe mental illness in central and south-western Uganda. The interviews were conducted, centered on personal experiences and influences on risky sexual behaviors for the persons with severe mental illness, targeting insights into the nuanced interplay of severe mental illness and sexual behavior. For caregivers and mental health specialists, the interviews were conducted to gain a comprehensive understanding of the unique challenges, perspectives, and experiences they encounter in providing support and treatment respectively. The interviews were tape-recorded and transcribed verbatim. Framework analysis of transcribed interviews, using NVivo11 software that helped to systematically organize and code data within the predetermined and emergent thematic framework, we were able to identify patterns and themes to address the research question and objective. Results The study findings underscored a pervasive pattern of engaging in risky sexual behavior among individuals coping with severe mental illness, a growing concern traditionally associated with sexually transmitted infections like HIV and AIDS, unwanted pregnancies, and sexual encounters with strangers. This problem was largely attributed to factors such as compromised judgment due to underlying morbidity, abnormally high libido, poverty, desperation, and inadequate social support. Additionally, sexual deprivation, often a result of stigma, discrimination, and prolonged periods of hospitalization, was found to contribute to irresponsible and risky sexual acts. Respondents also highlighted certain practices and structural weaknesses within hospital environments, such as stripping patients naked when going to seclusion rooms and inadequate patient monitoring. Conclusions The findings underscore the need for targeted interventions addressing both individual and structural factors to alleviate the risks associated with sexual behavior among individuals with severe mental illness. PubDate: 2024-04-08 DOI: 10.1007/s44155-024-00071-7
Abstract: Background Moral distress is recognized as a problem affecting nurse professionals globally. Unaddressed moral distress harms nurses’ physical and mental health, the quality of patient care, and the performance of healthcare teams and organizations. However, evidence on the magnitude and risk factors of moral distress is limited in Ethiopia in general and in the study area in particular. Thus, this study aimed to assess the magnitude of moral distress and associated factors among nurses working in Adama Comprehensive Specialized Hospital Medical College, central Ethiopia, 2023. Methods A facility-based cross-sectional study was conducted from January 1 to 30, 2023, with 219 nurses. A simple random sampling technique was employed to select the study participants. A self-administered structured questionnaire was used for data collection and Moral Distress Scale-Revised (MDS-R) was used to assess moral distress. Data were checked, coded, and entered into Epi info version 7, and then exported to the Statistical Package for Social Science version 26 for analysis. Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with moral distress. The odds ratio with its 95% confidence interval was used as a measure of association and statistical significance was declared at a p-value < 0.05. Result A total of 212 nurses participated in the analysis making the response rate 96.8%. The magnitude of moral distress was 86.8% (95% CI 82.1%, 91.0%). Perceived powerlessness (AOR = 6.08; 95% CI 1.69, 11.8), lack of confidence (AOR = 7.08; 95% CI 2.05–14.41), inadequate staffing (AOR = 12.46; 95% CI 3.28,15.1), and perceived weak organizational support (AOR = 11.59; 95% CI 2.8,17.33) were significantly associated with moral distress. Conclusion The magnitude of moral distress was high among nurses in the study setting. Perceived powerlessness, lack of confidence, inadequate staffing, and perceived weak organizational support were independent determinants of moral distress. Thus, creating adequate number of staff, and establishing acceptable organizational policies are ways to reduce moral distress. PubDate: 2024-03-26 DOI: 10.1007/s44155-024-00072-6
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