Healthcare

13 pages, 247 KiB

Open AccessArticle

Persons with Dementia Living at Home or in Nursing Homes in Nine Swedish Urban or Rural Municipalities

by Connie Lethin, Ingalill Rahm Hallberg, Emme-Li Vingare and Lottie Giertz

Healthcare 2019, 7(2), 80; https://doi.org/10.3390/healthcare7020080 - 25 Jun 2019

Cited by 5 | Viewed by 3624

The methodology from the “RightTimePlaceCare” study of dementia care was tested locally in terms of relevance, acceptability and attrition. Comparing persons with dementia (PwDs) receiving home care (HC) with PwDs living in nursing homes (NHs), in urban versus rural areas, regarding their health [...] Read more.

The methodology from the “RightTimePlaceCare” study of dementia care was tested locally in terms of relevance, acceptability and attrition. Comparing persons with dementia (PwDs) receiving home care (HC) with PwDs living in nursing homes (NHs), in urban versus rural areas, regarding their health conditions and informal caregiver burden was also done. Standardized measurements regarding sociodemographic, and physical and mental health was used. Questions related to legal guardianship were added. Interviews were conducted with PwDs and their caregivers in HC (n = 88) and in NHs (n = 58). Bivariate and multivariate logistic regression analysis was used. The attrition rate was higher in HC. In the bivariate regression model, for HC and NH, living at home was significantly associated with more severe neuropsychiatric symptoms (p ≤ 0.001) and being cared by a spouse (p = 0.008). In NH, the informal caregivers were significantly younger (p = 0.003) and living in rural areas (p = 0.007) and more often in paid work (p ≤ 0.001). In the multivariate regression model, informal caregivers were significantly younger (p = 0.007) when caring for a PwD in an NH and caregiver burden was significantly higher in HC and in urban areas (p = 0.043). Legal guardianship was very low. Professionals should acknowledge that PwDs in HC have more behavioural problems and caregivers in urban areas report higher caregiver burden. Full article

14 pages, 705 KiB

Open AccessArticle

Development and Process Evaluation of a Complex Intervention for Improving Nutrition among Hospitalised Patients: A Mixed Methods Study

by Shelley Roberts, Laurie Grealish, Lauren T. Williams, Zane Hopper, Julie Jenkins, Alan Spencer and Andrea P. Marshall

Healthcare 2019, 7(2), 79; https://doi.org/10.3390/healthcare7020079 - 24 Jun 2019

Cited by 9 | Viewed by 4186

Abstract

Hospital-acquired malnutrition is a significant issue with complex aetiology, hence nutrition interventions must be multifaceted and context-specific. This paper describes the development, implementation and process evaluation of a complex intervention for improving nutrition among medical patients in an Australian hospital. An integrated knowledge [...] Read more.

Hospital-acquired malnutrition is a significant issue with complex aetiology, hence nutrition interventions must be multifaceted and context-specific. This paper describes the development, implementation and process evaluation of a complex intervention for improving nutrition among medical patients in an Australian hospital. An integrated knowledge translation (iKT) approach was used for intervention development, informed by previous research. Intervention strategies targeted patients (via a nutrition intake monitoring system); staff (discipline-specific training targeting identified barriers); and the organisation (foodservice system changes). A process evaluation was conducted parallel to implementation assessing reach, dose, fidelity and staff responses to the intervention using a mixed-methods design (quantitative and qualitative approaches). Staff-level interventions had high fidelity and broad reach (61% nurses, 93% foodservice staff and all medical staff received training). Patient and organisation interventions were implemented effectively, but due to staffing issues, only reached around 60% of patients. Staff found all intervention strategies acceptable with benefits to practice. This study found an iKT approach useful for designing a nutrition intervention that was context-specific, feasible and acceptable to staff. This was likely due to engagement of multiple disciplines, identifying and targeting specific areas in need of improvement, and giving staff frequent opportunities to contribute to intervention development/implementation. Full article

(This article belongs to the Special Issue Patient and Staff Experience: An Exploration of Factors Contributing to Quality, Safety and Sound Governance)

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9 pages, 195 KiB

Open AccessArticle

The Information Needs of Adolescent Idiopathic Scoliosis Patients and Their Parents in the UK: An Online Survey

by Shaun Wellburn, Paul van Schaik and Josette Bettany-Saltikov

Healthcare 2019, 7(2), 78; https://doi.org/10.3390/healthcare7020078 - 20 Jun 2019

Cited by 5 | Viewed by 3709

Abstract

Patients’ involvement in decision-making regarding their own health care is considered to be of great importance. However, their information needs are frequently reported to be unfulfilled. Few studies have investigated the knowledge, information and support needs of adolescent idiopathic scoliosis (AIS) patients and [...] Read more.

Patients’ involvement in decision-making regarding their own health care is considered to be of great importance. However, their information needs are frequently reported to be unfulfilled. Few studies have investigated the knowledge, information and support needs of adolescent idiopathic scoliosis (AIS) patients and their families. Furthermore, previous studies have predominantly focussed on information needs relating to surgery. No previous studies have been conducted to specifically identify the information needs of AIS patients and their families. An online survey consisting of 18 questions was conducted to investigate the information needs of AIS patients and their families. Completed surveys of 83 participants (76 female, 7 male) from 44 differing postcode areas were analysed. The mean age of the respondents with scoliosis was 13.3 years (SD = 1.9; range = 10–18). Participants identified with feelings including worry, anxiety and being upset. The main information needs related to the cause and prognosis of the condition. Where participants had received information, there were contrasting views of the quality. The findings of this study stress the necessity for information materials to be accurate and applicable to each individual patient. Furthermore, the information should be presented in such a way as to be easily understandable, yet contain the necessary information required by AIS patients and their families. Full article

(This article belongs to the Special Issue Patient and Staff Experience: An Exploration of Factors Contributing to Quality, Safety and Sound Governance)

14 pages, 224 KiB

Open AccessArticle

Multi-Level Social Health Insurance System in the Age of Frequent Employment Change: The Urban Unemployment-Induced Insurance Transition and Healthcare Utilization in China

by Bocong Yuan, Jiannan Li, Lily Wu and Zhaoguo Wang

Healthcare 2019, 7(2), 77; https://doi.org/10.3390/healthcare7020077 - 13 Jun 2019

Cited by 13 | Viewed by 4483

Abstract

Job tenure has been significantly shortened with the prevalence of the gig economy around the world. Workers are faced with a new age of frequent employment change. This emerging situation is out of expectation of social health insurance policymakers. As the multi-level social [...] Read more.

Job tenure has been significantly shortened with the prevalence of the gig economy around the world. Workers are faced with a new age of frequent employment change. This emerging situation is out of expectation of social health insurance policymakers. As the multi-level social health insurance system in China is closely associated with employment status; urban workers cannot enjoy the urban employee basic medical insurance (UEBMI) during the unemployment period. At this time, unemployed rural-to-urban migrant workers can only rely on the new cooperative medical scheme (NCMS) and unemployed urban residents can only rely on the urban resident basic medical insurance (URBMI). This study provides a preliminary analysis on healthcare utilization change triggered by the unemployment-induced social health insurance transition that has never been investigated. Using the data of a nationwide survey, empirical results show that the unemployment-induced social health insurance transition can significantly deteriorate the healthcare utilization of insurance beneficiaries experiencing the transitions from the UEBMI to the NCMS (or from the UEBMI to the URBMI). Specifically, the outpatient service quality and the conventional physical examination become worse, and the out-of-pocket expenditure increases. Therefore, the multi-level social health insurance system currently in effect can expose workers to a high risk of insufficient health security in the age of frequent employment change. Full article

8 pages, 859 KiB

Open AccessCommentary

Community Empowerment and Community Partnerships in Nursing Decision-Making

by Pedro Melo and Odete Alves

Healthcare 2019, 7(2), 76; https://doi.org/10.3390/healthcare7020076 - 12 Jun 2019

Cited by 14 | Viewed by 14378

Abstract

Community empowerment has been studied as a process and result phenomenon throughout the last 40 years. Community partnership, which has been studied during the last 20 years, has been identified as a key process to promote intervention and research within communities. In this [...] Read more.

Community empowerment has been studied as a process and result phenomenon throughout the last 40 years. Community partnership, which has been studied during the last 20 years, has been identified as a key process to promote intervention and research within communities. In this paper, we introduce the relation between these two concepts, from the research that is being developed at the Centre for Interdisciplinary Health Research (CIIS) in Universidade Católica Portuguesa. We comment on the available evidence regarding community partnership and community empowerment within the Nursing Decision-Making process. There is a particular focus on Community Health Nursing Specialists (CHNS) and the aim to promote the identification of CHNS as potential community partnership developers within society. It is also important to analyze how community partnership processes are intentionally integrated as a nursing intervention within the nursing process. This analysis should occur from the nursing diagnosis to the evaluation of health gains in communities sensitive to CHNS care in a Nursing Theoretical Model developed from a Nursing PhD process—the Community Assessment, Intervention, and Empowerment Model. Full article

(This article belongs to the Special Issue Feature Papers in Healthcare in 2019)

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10 pages, 598 KiB

Open AccessArticle

Integrating Diverse Disciplines to Enhance Interprofessional Competency in Healthcare Delivery

by Tiffany Champagne-Langabeer, Lee Revere, Mariya Tankimovich, Erica Yu, Robert Spears and Jennifer Lee Swails

Healthcare 2019, 7(2), 75; https://doi.org/10.3390/healthcare7020075 - 10 Jun 2019

Cited by 11 | Viewed by 7309

Abstract

Interprofessional education (IPE) typically involves clinical simulation exercises with students from medical and nursing schools. Yet, healthcare requires patient-centered teams that include diverse disciplines. Students from public health and informatics are rarely incorporated into IPE, signaling a gap in current educational practices. In [...] Read more.

Interprofessional education (IPE) typically involves clinical simulation exercises with students from medical and nursing schools. Yet, healthcare requires patient-centered teams that include diverse disciplines. Students from public health and informatics are rarely incorporated into IPE, signaling a gap in current educational practices. In this study, we integrated students from administrative and non-clinical disciplines into traditional clinical simulations and measured the effect on communication and teamwork. From July 2017–July 2018, 408 students from five schools (medicine, nursing, dentistry, public health, and informatics) participated in one of eight three-hour IPE clinical simulations with Standardized Patients and electronic health record technologies. Data were gathered using a pre-test–post-test interventional Interprofessional Collaborative Competency Attainment Survey (ICCAS) and through qualitative evaluations from Standardized Patients. Of the total 408 students, 386 (94.6%) had matched pre- and post-test results from the surveys. There was a 15.9% improvement in collaboration overall between the pre- and post-tests. ICCAS competencies showed improvements in teamwork, communication, collaboration, and conflict management, with an average change from 5.26 to 6.10 (t = 35.16; p < 0.001). We found by creating new clinical simulations with additional roles for non-clinical professionals, student learners were able to observe and learn interprofessional teamwork from each other and from faculty role models. Full article

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10 pages, 1306 KiB

Open AccessArticle

Self-Assessment of Preparedness among Critical Care Trainees Transitioning from Fellowship to Practice

by Laura Watkins, Matthew DiMeglio and Krzysztof Laudanski

Healthcare 2019, 7(2), 74; https://doi.org/10.3390/healthcare7020074 - 30 May 2019

Cited by 4 | Viewed by 3750

Abstract

This study evaluated the subjective assessment of preparedness needs of critical care trainees and recent graduates between 2013 and 2014. A questionnaire was developed and validated by the subcommittee of the In-Training Section of Society of Critical Care Medicine (SCCM). The survey was [...] Read more.

This study evaluated the subjective assessment of preparedness needs of critical care trainees and recent graduates between 2013 and 2014. A questionnaire was developed and validated by the subcommittee of the In-Training Section of Society of Critical Care Medicine (SCCM). The survey was deployed twice between December 2013 and January 2014 via email to any trainee or individual graduated from a critical care fellowship within the previous three years. Six percent (180) of all individuals completed the survey, and 67% of respondents had recently interviewed for a job. Northeast was the preferred location for a job (47%), and academia was favored over private practice (80% vs. 15%). Of the respondents that secured an interview, 55% felt prepared for the interview, 67% felt prepared to build an adequate job portfolio, 33% received formal guidance from their mentor/training program. 89% of total respondents agreed it is important to participate in a formal training course in job search, portfolio development, and interviewing process. The preferred sources of training were equally distributed between their home institution, webinars, and SCCM. There is an ongoing need in education regarding the transition period from fellowship to practice. Full article

(This article belongs to the Special Issue Feature Papers in Healthcare in 2019)

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12 pages, 528 KiB

Open AccessFeature PaperArticle

Perspectives of Stakeholders on Technology Use in the Care of Community-Living Older Adults with Dementia: A Systematic Literature Review

by Leonieke C. van Boekel, Eveline J.M. Wouters, Bea M. Grimberg, Nardo J.M. van der Meer and Katrien G. Luijkx

Healthcare 2019, 7(2), 73; https://doi.org/10.3390/healthcare7020073 - 28 May 2019

Cited by 34 | Viewed by 8173

Abstract

Although technology has the potential to promote aging in place, the use of technology remains scarce among community-living older adults with dementia. A reason might be that many stakeholders are involved who all have a different perspective on technology use (i.e., needs, wishes, [...] Read more.

Although technology has the potential to promote aging in place, the use of technology remains scarce among community-living older adults with dementia. A reason might be that many stakeholders are involved who all have a different perspective on technology use (i.e., needs, wishes, attitudes, possibilities, and difficulties). We systematically searched the literature in order to provide an overview of perspectives of different stakeholders on technology use among community-living older adults with dementia. After selection, 46 studies were included. We mainly found perspectives of informal caregivers and, to a lesser extent, of persons with dementia and formal caregivers. Perspectives of suppliers of technology were not present. Shared perspectives among persons with dementia and informal and formal caregivers were, among other things, ease of use, stability and flexibility of technology, importance of privacy, and confidentiality. We also found that among older persons, fun and pleasure, in addition to enhancing freedom and independence, facilitates technology use. Informal caregivers’ peace of mind and relief of burden also appeared to be important in using technologies. Formal caregivers value the potential of technologies to improve monitoring and communication. Insight in shared, and conflicting perspectives of stakeholders are essential to enhance the use of technology. Full article

(This article belongs to the Special Issue Creating Age-friendly Communities: Housing and Technology)

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18 pages, 273 KiB

Open AccessArticle

Understanding Male Caregivers’ Emotional, Financial, and Physical Burden in the United States

by Monika Lopez–Anuarbe and Priya Kohli

Healthcare 2019, 7(2), 72; https://doi.org/10.3390/healthcare7020072 - 22 May 2019

Cited by 27 | Viewed by 6184

Abstract

Men caregivers face caregiving burden, have weak support networks and are less likely to seek out programs which increase their caregiving capabilities and help them cope with this burden. Using the 2011 and 2015 National Study of Caregiving (NSOC) database and hierarchical regressions, [...] Read more.

Men caregivers face caregiving burden, have weak support networks and are less likely to seek out programs which increase their caregiving capabilities and help them cope with this burden. Using the 2011 and 2015 National Study of Caregiving (NSOC) database and hierarchical regressions, we studied the emotional, financial, and physical burden of male caregivers as spouses, sons, and other caregivers by assessing the impact of caregiver characteristics, tasks and resources for each subgroup. We highlighted the importance of using a nationally representative database for men caregivers only and emphasized that these caregivers are not a monolithic group. We found that all caregivers experienced these three burden types, particularly elevated emotional stress, with sons reporting the highest emotional and financial strain levels. Assisting with personal care was the most stressful task and caregivers vastly under-utilized support and training. Our results suggest that burden suppressants included having family and friends help with caregiving, having time to decompress, and feeling appreciated by the care recipient. These findings offer insight for devising future policies that intentionally include relationship and burden type to encourage improved and more caregiving from men while supporting their well-being. Full article

(This article belongs to the Special Issue Aging, Chronic Disease, and the Impact of Long Term Care)

9 pages, 1647 KiB

Open AccessArticle

Proteomics Analysis of Urine to Examine Physical Effects of Warm Nano Mist Sauna Bathing

by Yoshitoshi Hirao, Naohiko Kinoshita, Bo Xu, Suguru Saito, Ali F. Quadery, Amr Elguoshy, Keiko Yamamoto and Tadashi Yamamoto

Healthcare 2019, 7(2), 71; https://doi.org/10.3390/healthcare7020071 - 19 May 2019

Viewed by 4202

Abstract

Conventional sauna bathing may have some health benefits as it facilitates relaxing, detoxing and promoting metabolism. However, conventional sauna bathing at a high temperature may be harmful for the body by increasing the risk of heart failure. The nano-mist sauna has been developed [...] Read more.

Conventional sauna bathing may have some health benefits as it facilitates relaxing, detoxing and promoting metabolism. However, conventional sauna bathing at a high temperature may be harmful for the body by increasing the risk of heart failure. The nano-mist sauna has been developed to provide nano-size water particles at a lower temperature. Hence, nano-mist sauna bathing is expected to be useful for health without the risks that arise at high temperatures. In this study, we performed a comprehensive proteomics analysis of urine samples obtained from healthy volunteers before and after they had taken a sauna bath with nano-mist (n = 10) or with conventional mist (n = 10) daily for two weeks (4 groups). The average numbers of urine proteins identified by liquid chromatography-linked mass chromatography in each group varied from 678 to 753. Interestingly, the protein number was increased after sauna bathing both with nano-mist or with conventional mist. Quantitative analysis indicated that considerable numbers of proteins were obviously up-regulated, with more than two-folds in urine samples after the nano-mist sauna bathing. The KEGG pathway analysis showed significant stimulation of the lysosome pathway (p = 5.89E−6) after the nano-mist bathing, which may indicate the nano-mist sauna bathing promotes metabolism related to the lysosome pathway more efficiently than conventional mist sauna bathing and may provide more health benefits. Full article

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24 pages, 3717 KiB

Open AccessArticle

Mixed Borrelia burgdorferi and Helicobacter pylori Biofilms in Morgellons Disease Dermatological Specimens

by Marianne J. Middelveen, Katherine R. Filush, Cheryl Bandoski, Rumanah S. Kasliwala, Anthony Melillo, Raphael B. Stricker and Eva Sapi

Healthcare 2019, 7(2), 70; https://doi.org/10.3390/healthcare7020070 - 17 May 2019

Cited by 8 | Viewed by 48095

Abstract

Background: Morgellons disease (MD) is a dermopathy that is associated with tick-borne illness. It is characterized by spontaneously developing skin lesions containing embedded or projecting filaments, and patients may also experience symptoms resembling those of Lyme disease (LD) including musculoskeletal, neurological and cardiovascular [...] Read more.

Background: Morgellons disease (MD) is a dermopathy that is associated with tick-borne illness. It is characterized by spontaneously developing skin lesions containing embedded or projecting filaments, and patients may also experience symptoms resembling those of Lyme disease (LD) including musculoskeletal, neurological and cardiovascular manifestations. Various species of Borrelia and co-infecting pathogens have been detected in body fluids and tissue specimens from MD patients. We sought to investigate the coexistence of Borrelia burgdorferi (Bb) and Helicobacter pylori (Hp) in skin specimens from MD subjects, and to characterize their association with mixed amyloid biofilm development. Methods: Testing for Bb and Hp was performed on dermatological specimens from 14 MD patients using tissue culture, immunohistochemical (IHC) staining, polymerase chain reaction (PCR) testing, fluorescent in situ hybridization (FISH) and confocal microscopy. Markers for amyloid and biofilm formation were investigated using histochemical and IHC staining. Results: Bb and Hp were detected in dermatological tissue taken from MD lesions. Bb and Hp tended to co-localize in foci within the epithelial tissue. Skin sections exhibiting foci of co-infecting Bb and Hp contained amyloid markers including β-amyloid protein, thioflavin and phosphorylated tau. The biofilm marker alginate was also found in the sections. Conclusions: Mixed Bb and Hp biofilms containing β-amyloid and phosphorylated tau may play a role in the evolution of MD. Full article

(This article belongs to the Special Issue Lyme Disease and Related Tickborne Infections)

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14 pages, 2404 KiB

Open AccessArticle

Modeling-Based Assessment of 3D Printing-Enabled Meniscus Transplantation

by Zimeng Zhang, Qian Wu, Li Zeng and Shiren Wang

Healthcare 2019, 7(2), 69; https://doi.org/10.3390/healthcare7020069 - 10 May 2019

Cited by 2 | Viewed by 4591

Abstract

3D printing technology is able to produce personalized artificial substitutes for patients with damaged menisci. However, there is a lack of thorough understanding of 3D printing-enabled (3DP-enabled) meniscus transplantation and its long-term advantages over traditional transplantation. To help health care stakeholders and patients [...] Read more.

3D printing technology is able to produce personalized artificial substitutes for patients with damaged menisci. However, there is a lack of thorough understanding of 3D printing-enabled (3DP-enabled) meniscus transplantation and its long-term advantages over traditional transplantation. To help health care stakeholders and patients assess the value of 3DP-enabled meniscus transplantation, this study compares the long-term cost and risk of this new paradigm with traditional transplantation by simulation. Pathway models are developed to simulate patients’ treatment process during a 20-year period, and a Markov process is used to model the state transitions of patients after transplantation. A sensitivity analysis is also conducted to show the effect of quality of 3D-printed meniscus on model outputs. The simulation results suggest that the performance of 3DP-enabled meniscus transplantation depends on quality of 3D-printed meniscus. The conclusion of this study is that 3DP-enabled meniscus transplantation has many advantages over traditional meniscus transplantation, including a minimal waiting time, perfect size and shape match, and potentially lower cost and risk in the long term. Full article

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22 pages, 1101 KiB

Open AccessArticle

Living Alone Among Older Adults in Canada and the U.S.

by Sharon M. Lee and Barry Edmonston

Healthcare 2019, 7(2), 68; https://doi.org/10.3390/healthcare7020068 - 07 May 2019

Cited by 26 | Viewed by 6946

Abstract

Increasing proportions of people, including older adults, live alone. Studying living arrangements of the elderly is important because these affect and reflect general well-being of the elderly and inform communities’ response to elderly housing needs. We analyze data from the 2006 Canadian Census [...] Read more.

Increasing proportions of people, including older adults, live alone. Studying living arrangements of the elderly is important because these affect and reflect general well-being of the elderly and inform communities’ response to elderly housing needs. We analyze data from the 2006 Canadian Census and the 2006 American Community Survey to examine living alone among non-married older adults aged 55 and older in Canada and the U.S. The paper has two parts. First, we compare native- and foreign-born elderly to see if immigrants are less likely to live alone. Second, we examine factors associated with living alone among older immigrants. While older immigrants in both countries are less likely to live alone, the large differences are substantially reduced once various explanatory variables are considered. Comparisons of four gender/country groups of older immigrants show the positive role of economic and acculturation factors on living alone among older immigrants. With few exceptions, predictors of living alone are similar for older immigrants in Canada and the U.S.: living alone is mainly explained by a combination of economic and acculturation factors, taking demographic variables into account. Findings underline the need for age-friendly housing with innovative design and technology that can accommodate older people who live alone, including older immigrants who may have different needs and cultural preferences. Full article

(This article belongs to the Special Issue Creating Age-friendly Communities: Housing and Technology)

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9 pages, 361 KiB

Open AccessArticle

Among Trauma Patients, Younger Men with Ventilator-Associated Pneumonia Have Worse Outcomes Compared to Older Men—An Exploratory Study

by Duraid Younan, Sarah J. Delozier, Nathaniel McQuay, John Adamski, Aisha Violette, Andrew Loudon, Jeffrey Ustin, Regan Berg, Glen Tinkoff, Matthew L. Moorman and UHRISES Research Consortium

Healthcare 2019, 7(2), 67; https://doi.org/10.3390/healthcare7020067 - 30 Apr 2019

Cited by 2 | Viewed by 3782

Abstract

Background: Ventilator-associated pneumonia is associated with significant morbidity. Although the association of gender with outcomes in trauma patients has been debated for years, recently, certain authors have demonstrated a difference. We sought to compare the outcomes of younger men and women to older [...] Read more.

Background: Ventilator-associated pneumonia is associated with significant morbidity. Although the association of gender with outcomes in trauma patients has been debated for years, recently, certain authors have demonstrated a difference. We sought to compare the outcomes of younger men and women to older men and women, among critically ill trauma patients with ventilator-associated pneumonia (VAP). Methods: We reviewed our trauma data base for trauma patients with ventilator-associated pneumonia admitted to our trauma intensive care unit between January 2016 and June 2018. Data collected included demographics, injury mechanism and severity (ISS), admission vital signs and laboratory data and outcome measures including hospital length of stay, ICU stay and survival. Patients were also divided into younger (<50) and older (≥50) to account for hormonal status. Linear regression and binary logistic regression models were performed to compare younger men to older men and younger women to older women, and to examine the association between gender and hospital length of stay (LOS), ICU stay (ICUS), and survival. Results: Forty-five trauma patients admitted to our trauma intensive care unit during the study period (January 2016 to August 2018) had ventilator-associated pneumonia. The average age was 58.9 ± 19.6 years with mean ISS of 18.2 ± 9.8. There were 32 (71.1%) men, 27 (60.0%) White, and 41 (91.1%) had blunt trauma. Mean ICU stay was 14.9 ± 11.4 days and mean total hospital length of stay (LOS) was 21.5 ± 14.6 days. Younger men with VAP had longer hospital LOS 28.6 ± 17.1 days compared to older men 16.7 ± 6.6 days, (p < 0.001) and longer intensive care unit stay 21.6 ± 15.6 days compared to older men 11.9 ± 7.3 days (p = 0.02), there was no significant difference in injury severity (ISS was 22.2 ± 8.4 vs. 17 ± 8, p = 0.09). Conclusions: Among trauma patients with VAP, younger men had longer hospital length of stay and a trend towards longer ICU stay. Further research should focus on the mechanisms behind this difference in outcome using a larger database. Full article

(This article belongs to the Special Issue Feature Papers in Healthcare in 2019)

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11 pages, 947 KiB

Open AccessArticle

Risk Factors of Lyme Disease: An Intersection of Environmental Ecology and Systems Science

by Nasser Sharareh, Rachael P. Behler, Amanda B. Roome, Julian Shepherd, Ralph M. Garruto and Nasim S. Sabounchi

Healthcare 2019, 7(2), 66; https://doi.org/10.3390/healthcare7020066 - 30 Apr 2019

Cited by 8 | Viewed by 6534

Abstract

Lyme disease (LD) cases have been on the rise throughout the United States, costing the healthcare system up to $1.3 billion per year, and making LD one of the greatest threats to public health. Factors influencing the number of LD cases range from [...] Read more.

Lyme disease (LD) cases have been on the rise throughout the United States, costing the healthcare system up to $1.3 billion per year, and making LD one of the greatest threats to public health. Factors influencing the number of LD cases range from environmental to system-level variables, but little is known about the influence of vegetation (canopy, understory, and ground cover) and human behavioral risk on LD cases and exposure to infected ticks. We determined the influence of various risk factors on the risk of exposure to infected ticks on 22 different walkways using multinomial logistic regression. The model classifies the walkways into high-risk and low-risk categories with 90% accuracy, in which the understory, human risk, and number of rodents are significant indicators. These factors should be managed to control the risk of transmission of LD to humans. Full article

(This article belongs to the Special Issue Lyme Disease and Related Tickborne Infections)

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18 pages, 267 KiB

Open AccessReview

Characteristics of Future Models of Integrated Outpatient Care

by Alan Leviton, Julia Oppenheimer, Madeline Chiujdea, Annalee Antonetty, Oluwafemi William Ojo, Stephanie Garcia, Sarah Weas, Eric Fleegler, Eugenia Chan and Tobias Loddenkemper

Healthcare 2019, 7(2), 65; https://doi.org/10.3390/healthcare7020065 - 27 Apr 2019

Cited by 2 | Viewed by 5975

Abstract

Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we described how patients and their families (or caregivers) can work with members of the medical care team to achieve these [...] Read more.

Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we described how patients and their families (or caregivers) can work with members of the medical care team to achieve these twin goals of maintaining—and perhaps improving—high-quality care and minimizing costs. We described how increased self-management enables patients and their families/caregivers to provide electronic patient-reported outcomes (i.e., symptoms, events) (ePROs), as frequently as the patient or the medical care team consider appropriate. These capabilities also allow ongoing assessments of physiological measurements/phenomena (mHealth). Remote surveillance of these communications allows longer intervals between (fewer) patient visits to the medical-care team, when this is appropriate, or earlier interventions, when it is appropriate. Systems are now available that alert medical care providers to situations when interventions might be needed. Full article

8 pages, 205 KiB

Open AccessArticle

The Role of Governments in the Implementation of Patient Safety and Patient Safety Incident Reporting in Indonesia: A Qualitative Study

by Inge Dhamanti, Sandra G. Leggat and Simon Barraclough

Healthcare 2019, 7(2), 64; https://doi.org/10.3390/healthcare7020064 - 24 Apr 2019

Cited by 5 | Viewed by 4460

Abstract

(1) Background: A patient safety incident reporting system was introduced in Indonesian hospitals in 2006; however, under-reporting of patient safety incidents is evident. The government plays a vital role in the implementation of a national system. Therefore, this study focuses on how the [...] Read more.

(1) Background: A patient safety incident reporting system was introduced in Indonesian hospitals in 2006; however, under-reporting of patient safety incidents is evident. The government plays a vital role in the implementation of a national system. Therefore, this study focuses on how the Indonesian government has been undertaking its role in patient safety at provincial and city/district levels, including incident reporting according to the National Guideline for Hospital Patient Safety. (2) Methods: This study employed a qualitative approach with interviews of 16 participants from seven organizations. The data were managed using NVivo and thematically analyzed. (3) Results: The findings revealed several problems at the macro-, meso-, and micro-level as the government was weak in monitoring and evaluation. The District Health Office (DHO) and Provincial Health Office (PHO) were not involved in incident reporting, and there was a lack of government support for the hospitals. (4) Conclusions: The DHO and PHO have not carried out their roles related to patient safety as mentioned in the national guidelines. Lack of commitment to and priority of patient safety, the complexity of the bureaucratic structure, and a lack of systematic partnership and collaboration are problems that need to be addressed by systematic improvement. To ensure effective and efficient national outcomes, the three levels of government need to work more closely. Full article

(This article belongs to the Special Issue Patient and Staff Experience: An Exploration of Factors Contributing to Quality, Safety and Sound Governance)

12 pages, 239 KiB

Open AccessReview

A Review of the Complex Role of Family Caregivers as Health Team Members and Second-Order Patients

by Deborah Witt Sherman

Healthcare 2019, 7(2), 63; https://doi.org/10.3390/healthcare7020063 - 24 Apr 2019

Cited by 38 | Viewed by 6858

Abstract

In Palliative Care, the unit of care is the patient and their family. Although members of the health care team often address the family caregiver’s opinions and concerns, the focus of care remains on the needs of the patient. The readiness and willingness [...] Read more.

In Palliative Care, the unit of care is the patient and their family. Although members of the health care team often address the family caregiver’s opinions and concerns, the focus of care remains on the needs of the patient. The readiness and willingness of the family caregiver is often overlooked as they are expected to assume a complex caregiving role. When family caregivers are not intellectually or emotionally prepared or physically capable, the caregiver is at high risk for serious health issues and cognitive, emotional, and physical decline particularly as caregiving extends over time. Family caregivers are often a neglected and at-risk population. Illustrated through the use of a case study, this article addresses the complex role of family caregivers, as both health team members and second-order patients. It emphasizes the importance of family assessment and interventions to balance the burdens and benefits of family caregiving and protect caregivers’ health and well-being. Full article

(This article belongs to the Special Issue Feature Papers in Healthcare in 2019)

12 pages, 893 KiB

Open AccessReview

Review of Programs for Persons Facing Death with Dementia

by Ladislav Volicer

Healthcare 2019, 7(2), 62; https://doi.org/10.3390/healthcare7020062 - 15 Apr 2019

Cited by 10 | Viewed by 5272

Abstract

Background: Persons with advanced dementia cannot initiate activities because of the executive dysfunction. The lack of activities was identified as one of the most important factors contributing to behavioral problems of these persons. The unmet needs were boredom/sensory deprivation, loneliness/need for social interaction, [...] Read more.

Background: Persons with advanced dementia cannot initiate activities because of the executive dysfunction. The lack of activities was identified as one of the most important factors contributing to behavioral problems of these persons. The unmet needs were boredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activities. There is a need for activities designed specifically for residents with advanced dementia. Objective: A description of patient’s needs and of programs that intend to maintain quality of life for people with dementia and facing death. Data sources: A literature review of programs used for persons with advanced dementia and residing in long-term facilities, using the PubMed data base and collateral sources. Results: Since palliative care is appropriate for persons with advanced dementia, attention has to be paid to three following important aspects of care: Medical issues, behavioral symptoms, and meaningful activities. Medical interventions should be limited to those which have more benefits than burdens, behavioral symptoms should be distinguished according to the context in which they occur, and treated by non-pharmacological interventions that involve meaningful activities. This review describes four programs that may promote the quality of life in persons with advanced dementia and facing death. They are designed for persons with advanced dementia, taking into account their functional impairments. Most of these programs involve short infrequent sessions. In contrast, Namaste Care is a daily extended program of enhanced nursing care that can provide quality of life until the last breath. Conclusions: It is possible to maintain quality life for people with advanced dementia if a special program of activities is available. Full article

(This article belongs to the Special Issue Aging, Chronic Disease, and the Impact of Long Term Care)

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17 pages, 270 KiB

Open AccessArticle

Household Registration System, Migration, and Inequity in Healthcare Access

by Bocong Yuan, Jiannan Li, Zhaoguo Wang and Lily Wu

Healthcare 2019, 7(2), 61; https://doi.org/10.3390/healthcare7020061 - 11 Apr 2019

Cited by 12 | Viewed by 5757

Abstract

This study investigates the influence of the household registration system on rural–urban disparity in healthcare access (including healthcare quality, blood pressure check, blood test, vision test, dental examination, and breast exam), using data from a large-scale nationwide life history survey that covered 150 [...] Read more.

This study investigates the influence of the household registration system on rural–urban disparity in healthcare access (including healthcare quality, blood pressure check, blood test, vision test, dental examination, and breast exam), using data from a large-scale nationwide life history survey that covered 150 counties across 28 provinces and municipalities in China. In contrast to the findings of many previous studies that emphasize the disparity in the residence place as the cause of rural–urban disparity in healthcare access, this study finds that the residence place just has a very limited influence on healthcare access in China, and what really matters is the household registration type. Our empirical results show that people with a non-rural household registration type generally have better healthcare access than those with a rural one. For rural residents, changing the registration type of their household (from rural to non-rural) can improve their healthcare access, whereas changing the residence place or migrating from rural to urban areas have no effect. Therefore, mere rural-to-urban migration may not be a valid measure to eliminate the rural–urban disparity in healthcare access, unless the institution of healthcare resource allocation is reformed. Full article

18 pages, 1680 KiB

Open AccessArticle

Technology to Support Aging in Place: Older Adults’ Perspectives

by Shengzhi Wang, Khalisa Bolling, Wenlin Mao, Jennifer Reichstadt, Dilip Jeste, Ho-Cheol Kim and Camille Nebeker

Healthcare 2019, 7(2), 60; https://doi.org/10.3390/healthcare7020060 - 10 Apr 2019

Cited by 158 | Viewed by 30029

Abstract

The U.S. population over 65 years of age is increasing. Most older adults prefer to age in place, and technologies, including Internet of things (IoT), Ambient/Active Assisted Living (AAL) robots and other artificial intelligence (AI), can support independent living. However, a top-down design [...] Read more.

The U.S. population over 65 years of age is increasing. Most older adults prefer to age in place, and technologies, including Internet of things (IoT), Ambient/Active Assisted Living (AAL) robots and other artificial intelligence (AI), can support independent living. However, a top-down design process creates mismatches between technologies and older adults’ needs. A user-centered design approach was used to identify older adults’ perspectives regarding AAL and AI technologies and gauge interest in participating in a co-design process. A survey was used to obtain demographic characteristics and assess privacy perspectives. A convenience sample of 31 retirement community residents participated in one of two 90-min focus group sessions. The semi-structured group interview solicited barriers and facilitators to technology adoption, privacy attitudes, and interest in project co-design participation to inform technology development. Focus group sessions were audiotaped and professionally transcribed. Transcripts were reviewed and coded to identify themes and patterns. Descriptive statistics were applied to the quantitative data. Identified barriers to technology use included low technology literacy, including lack of familiarity with terminology, and physical challenges, which can make adoption difficult. Facilitators included an eagerness to learn, interest in co-design, and a desire to understand and control their data. Most participants identified as privacy pragmatics and fundamentalists, indicating that privacy is important to older adults. At the same time, they also reported a willingness to contribute to the design of technologies that would facilitate aging independently. There is a need to increase technology literacy of older adults along with aging literacy of technologists. Full article

(This article belongs to the Special Issue Creating Age-friendly Communities: Housing and Technology)

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14 pages, 1403 KiB

Open AccessArticle

Using Deep Dive Methodology to Investigate an Increased Incidence of Hospital-Acquired Avoidable Category 2 and 3 Pressure Ulcers

by Martyne Horton-Jones, Emma Marsh, Sian Fumarola, Helen Wright-White, Wilfred McSherry and Trish Rowson

Healthcare 2019, 7(2), 59; https://doi.org/10.3390/healthcare7020059 - 08 Apr 2019

Cited by 2 | Viewed by 5327

Abstract

Background: Between October 2017 and March 2018, the Trust experienced significant winter pressures and an increase in category 2 and 3 hospital-acquired avoidable pressure ulcers. This review aimed to investigate the causal factors of this increase. Methods: A ‘Deep Dive’ review [...] Read more.

Background: Between October 2017 and March 2018, the Trust experienced significant winter pressures and an increase in category 2 and 3 hospital-acquired avoidable pressure ulcers. This review aimed to investigate the causal factors of this increase. Methods: A ‘Deep Dive’ review of 37 cases was undertaken in three stages: (i) assurance; ensure the increase was not due to insufficient equipment; (ii) collation of relevant data, including age, length of time in A&E, bed surface, number of internal moves; (iii) analysis identifying factors that might account for the observed increase. Findings: Age combined with prolonged length of time in A&E, being nursed on a trolley followed by three or four internal moves were observed in patients who developed pressure ulcers. Patient age was observed as a key factor, with those over 80 years experiencing pressure ulcers more frequently. Conclusion: The small size of this data suggests a need for the greater awareness of frailty issues in older people, timely assessment and intervention to prevent a chain of detrimental factors might be key to reduce and prevent hospital-acquired avoidable pressure ulcers. Recommendations for immediate action, education and future research have been made to the Trust Quality and Safety Committee. Full article

(This article belongs to the Special Issue Patient and Staff Experience: An Exploration of Factors Contributing to Quality, Safety and Sound Governance)

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14 pages, 1117 KiB

Open AccessArticle

A Supervised Pattern Analysis of the Length of Stay for Hip Replacement Admissions

by Dimitrios Zikos, Ashara Shrestha, Taylor Colotti and Leonidas Fegaras

Healthcare 2019, 7(2), 58; https://doi.org/10.3390/healthcare7020058 - 06 Apr 2019

Cited by 3 | Viewed by 4160

Abstract

Hip replacement is the most common surgical procedure among Medicare patients in the US and worldwide. The hospital length of stay (LOS) for hip replacement admissions is therefore important to be controlled, contributing to savings for hospitals. This study combined medical claims and [...] Read more.

Hip replacement is the most common surgical procedure among Medicare patients in the US and worldwide. The hospital length of stay (LOS) for hip replacement admissions is therefore important to be controlled, contributing to savings for hospitals. This study combined medical claims and hospital structure and service data to examine LOS fluctuations and trends, and admission distribution patterns, during weekdays, for hip replacement cases. The study furthermore examined associations of these patterns with the LOS performance. Most hospitals were found to admit hip replacement cases at the start of the week (Monday through Wednesday). There is an upward LOS trend as we approach late weekday admissions. Multiple linear regression analysis showed that LOS weekday inconsistencies, a large proportion of hip replacement admissions on Thursday and Friday, the government ownership status, the bed size, and the critical access status are associated with an increased LOS. On the other hand, the rate of hip replacement admissions over total ones, and the hospital being accredited, are associated with a lower LOS. Findings stress out the need for hospitals to maintain an effective and balanced distribution of hip replacement admissions, evenly during the week, and the need for standardized case management, to avoid practice variability and, therefore, LOS fluctuations for their hip replacement cases. Full article

(This article belongs to the Special Issue Feature Papers in Healthcare in 2019)

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10 pages, 1444 KiB

Open AccessArticle

Impact of Electronic Health Record Systems on Prescribing Errors in Pediatric Clinics

by Brooke L. Gildon, Michelle Condren and Christine C. Hughes

Healthcare 2019, 7(2), 57; https://doi.org/10.3390/healthcare7020057 - 05 Apr 2019

Cited by 8 | Viewed by 6335

Abstract

Medication errors are commonly reported in the pediatric population. While evidence supports the use of e-prescribing to prevent certain errors, prescribing with an electronic health record (EHR) system is not devoid of errors. Furthermore, the majority of EHRs are not equipped with functionalities [...] Read more.

Medication errors are commonly reported in the pediatric population. While evidence supports the use of e-prescribing to prevent certain errors, prescribing with an electronic health record (EHR) system is not devoid of errors. Furthermore, the majority of EHRs are not equipped with functionalities addressing pediatric needs. This study analyzes three unique EHRs in three pediatric clinics. It describes the functionality of each system and identifies errors found in e-prescribed prescriptions. Finally, the study estimates the proportion of e-prescribing errors that could have been avoided if those EHRs had met requirements set by the American Academy of Pediatrics (AAP). The number of prescriptions reviewed for Clinics 1, 2, and 3, respectively, were: 477, 408, and 633 with total error rates of 13.2%, 8.8%, and 6.6%. The clinic EHRs included 21%, 26%, and 47% of the AAP pediatric requirements for safe and effective e-prescribing for children. If all AAP elements had been included in the EHRs, over 83% of errors in the examined e-prescriptions could have been prevented. This study demonstrates that EHR systems used by many pediatric clinic practices do not meet the standard set forth by the AAP. To ensure our most vulnerable population is better protected, it is imperative that medical technology tools adequately consider pediatric needs during development and that this is reflected in selected EHR systems. Full article

(This article belongs to the Special Issue Rational Use of Medicines in Children)

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30 pages, 3294 KiB

Open AccessReview

Blockchain Technology in Healthcare: A Systematic Review

by Cornelius C. Agbo, Qusay H. Mahmoud and J. Mikael Eklund

Healthcare 2019, 7(2), 56; https://doi.org/10.3390/healthcare7020056 - 04 Apr 2019

Cited by 564 | Viewed by 60945

Abstract

Since blockchain was introduced through Bitcoin, research has been ongoing to extend its applications to non-financial use cases. Healthcare is one industry in which blockchain is expected to have significant impacts. Research in this area is relatively new but growing rapidly; so, health [...] Read more.

Since blockchain was introduced through Bitcoin, research has been ongoing to extend its applications to non-financial use cases. Healthcare is one industry in which blockchain is expected to have significant impacts. Research in this area is relatively new but growing rapidly; so, health informatics researchers and practitioners are always struggling to keep pace with research progress in this area. This paper reports on a systematic review of the ongoing research in the application of blockchain technology in healthcare. The research methodology is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and a systematic mapping study process, in which a well-designed search protocol is used to search four scientific databases, to identify, extract and analyze all relevant publications. The review shows that a number of studies have proposed different use cases for the application of blockchain in healthcare; however, there is a lack of adequate prototype implementations and studies to characterize the effectiveness of these proposed use cases. The review further highlights the state-of-the-art in the development of blockchain applications for healthcare, their limitations and the areas for future research. To this end, therefore, there is still the need for more research to better understand, characterize and evaluate the utility of blockchain in healthcare. Full article

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8 pages, 224 KiB

Open AccessReview

Studying the Evolving Knowledge of Adverse Drug Reactions in Order to Facilitate the Rational Use of Medicines in Paediatric Patients

by Kristina Star and Imti Choonara

Healthcare 2019, 7(2), 55; https://doi.org/10.3390/healthcare7020055 - 02 Apr 2019

Cited by 2 | Viewed by 6648

Abstract

Pharmacovigilance, which is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other possible drug-related problems, generates knowledge to facilitate the rational use of medicines. When a medicine is first marketed, there is limited information [...] Read more.

Pharmacovigilance, which is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other possible drug-related problems, generates knowledge to facilitate the rational use of medicines. When a medicine is first marketed, there is limited information on adverse drug reactions (ADRs), especially in paediatrics, where medicines are less likely to have been extensively studied. Knowledge in drug safety is built up over time when more (in number, and more heterogeneous) patients are treated than were studied in the randomised controlled trials preceding the marketing of a medicine. Previously not recognised ADRs are often initially described in case reports and case series. Prospective cohort studies are useful in determining the incidence and risk factors of common ADRs. Case series and pharmacovigilance reporting systems have been useful in identifying previously unknown uncommon ADRs and risk factors for specific ADRs. This brief review provides examples that illustrate how various study designs and data sources contribute to the evolving knowledge of ADRs that is essential to help develop guidelines and improve the rational use of medicines. Full article

(This article belongs to the Special Issue Rational Use of Medicines in Children)

17 pages, 883 KiB

Open AccessArticle

Citizens’ Juries: When Older Adults Deliberate on the Benefits and Risks of Smart Health and Smart Homes

by Neil H. Chadborn, Krista Blair, Helen Creswick, Nancy Hughes, Liz Dowthwaite, Oluwafunmilade Adenekan and Elvira Pérez Vallejos

Healthcare 2019, 7(2), 54; https://doi.org/10.3390/healthcare7020054 - 01 Apr 2019

Cited by 15 | Viewed by 6036

Abstract

Background: Technology-enabled healthcare or smart health has provided a wealth of products and services to enable older people to monitor and manage their own health conditions at home, thereby maintaining independence, whilst also reducing healthcare costs. However, despite the growing ubiquity of [...] Read more.

Background: Technology-enabled healthcare or smart health has provided a wealth of products and services to enable older people to monitor and manage their own health conditions at home, thereby maintaining independence, whilst also reducing healthcare costs. However, despite the growing ubiquity of smart health, innovations are often technically driven, and the older user does not often have input into design. The purpose of the current study was to facilitate a debate about the positive and negative perceptions and attitudes towards digital health technologies. Methods: We conducted citizens’ juries to enable a deliberative inquiry into the benefits and risks of smart health technologies and systems. Transcriptions of group discussions were interpreted from a perspective of life-worlds versus systems-worlds. Results: Twenty-three participants of diverse demographics contributed to the debate. Views of older people were felt to be frequently ignored by organisations implementing systems and technologies. Participants demonstrated diverse levels of digital literacy and a range of concerns about misuse of technology. Conclusion: Our interpretation contrasted the life-world of experiences, hopes, and fears with the systems-world of surveillance, efficiencies, and risks. This interpretation offers new perspectives on involving older people in co-design and governance of smart health and smart homes. Full article

(This article belongs to the Special Issue Creating Age-friendly Communities: Housing and Technology)

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12 pages, 1603 KiB

Open AccessArticle

Mental Health Issues in Madhya Pradesh: Insights from National Mental Health Survey of India 2016

by Arun Kokane, Abhijit Pakhare, Gopalkrishna Gururaj, Mathew Varghese, Vivek Benegal, Girish N. Rao, Banavaram Arvind, Mukesh Shukla, Arun Mitra, Kriti Yadav, Rajni Chatterji, Sukanya Ray and Akash Ranjan Singh

Healthcare 2019, 7(2), 53; https://doi.org/10.3390/healthcare7020053 - 31 Mar 2019

Cited by 15 | Viewed by 6663

Abstract

Background: About 14% of the global mental health burden is contributed by India. However, there exists a disparity in mental health patterns, utilization, and prioritization among various Indian states. The state of Madhya Pradesh is a low performer among Indian states, ranking lower [...] Read more.

Background: About 14% of the global mental health burden is contributed by India. However, there exists a disparity in mental health patterns, utilization, and prioritization among various Indian states. The state of Madhya Pradesh is a low performer among Indian states, ranking lower than the national average on the Human Development Index, Hunger Index, and Gross Domestic Product (GDP). The state also performes poorly on other health-related indicators. Objectives of Study: To estimate the prevalence and patterns of mental illnesses in the state of Madhya Pradesh, India. Material and Methods: This study used the multistage, stratified, random cluster sampling technique, with selection probability proportionate to size at each stage. A total of 3240 individuals 18 years and older were interviewed. The mixed-method study that was employed had both quantitative and qualitative components. The Mini International Neuropsychiatric Interview along with 10 other instruments were used. Results: The overall weighted prevalence for any mental illness was 13.9%, with 16.7% over the lifetime. The treatment gap for all of the mental health problems is very high (91%), along with high suicidal risk and substance use in the state. Conclusions: This study provides evidence of the huge burden of mental, behavioral, and substance use disorders as well as the treatment gap in Madhya Pradesh. This information is crucial for developing an effective prevention and control strategy. The high treatment gap in the state calls for coordinated efforts from all stakeholders, including policy makers, political leaders, health care professionals, and the society at large to give mental health care its due priority. These findings also highlight the need for multi-pronged interventions rooted in health policy directed at reducing the treatment gap in the short term and disease burden in the long run. Full article

(This article belongs to the Special Issue Mental Health Stigma in Healthcare Settings)

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Healthcare, Volume 7, Issue 2 (June 2019) – 28 articles

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