Smoke and malaria: are interventions to reduce exposure to indoor air pollution likely to increase exposure to mosquitoes?

Indoor air pollution from the domestic use of biomass fuels by poor households in developing countries is known to be harmful to health, and efforts are being made to address this problem by changes in fuel type, stove technology, house design and fuel-use practices. However, anecdotal evidence suggests that smoke may play an important role by providing protection from biting insects and that efforts to reduce smoke may increase exposure, particularly to mosquitoes and malaria. This paper reviews the literature relating to the repellent effect of smoke on mosquitoes and finds that there is currently no evidence that smoke from domestic fuel use provides effective protection from mosquitoes and malaria. Given the limited number and quality of studies, this finding cannot be interpreted as conclusive. The literature relating to house ventilation and mosquito entry was also reviewed, and an association between eaves spaces and increased indoor mosquito density was noted. Additionally, literature on the effect of soot on the efficacy of insecticide-treated bed nets was considered, but no direct impact was shown. Efforts to reduce indoor air pollution remain desirable even in areas of malaria transmission.     

Transitioning to telehealth? A guide to evaluating outcomes

ObjectivesTelehealth use has surged since the onset of the coronavirus disease 2019 (COVID-19) pandemic, but the evaluation of telehealth outcomes and performance has not necessarily matched the pace of its uptake. In this article we aim to guide the design of a telehealth evaluation system encompassing all four domains of the outcome measurement framework developed by the National Quality Forum (NQF) – access to care, cost, experience, and effectiveness. We aim to achieve this through proposing survey items that can be distributed to patients or clinicians as a questionnaire and providing suggestions on areas of focus for evaluation studies.MethodsUsing PubMed and Google Scholar search engines, we performed a literature review of articles related to the evaluation of telehealth outcomes that were published in English since 2000.ResultsWe found existing survey tools to assist the development of an evaluation questionnaire, and categorized items into the four NQF outcome domains. For each outcome domain, we also summarize existing work on evaluation and make recommendations on areas for future assessment. In particular, we found that telehealth accessibility and accommodations have been historically under-studied and provide tools to address this.ConclusionsEvaluating telehealth outcomes is critical to ensure efficient and high-quality care delivery, and we believe establishing an evaluation system will help practices assess and improve their telehealth systems as well as their ability to use telehealth to respond to the diverse needs of patients.Public Interest SummarySince the start of the coronavirus disease 2019 (COVID-19) pandemic, telehealth use has been on the rise. Evaluating outcomes related to telehealth is critically important, but given the urgency of telehealth uptake, many health systems and practices may not yet have evaluation systems in place. This article guides the design of a telehealth evaluation system by proposing several validated and novel survey questions that can be used as part of a patient or clinician questionnaire and suggesting important measures of outcome for evaluation studies to assess across the four domains of telehealth quality as outlined by the National Quality Forum (NQF) – access to care, cost, experience, and effectiveness. We present tools to reach priority populations who often lack access to remote care, including older adults, underrepresented minorities, and people with disabilities.     

Do patients want to disclose psychological problems to GPs?

BACKGROUND: GPs are an accessible health care provider for most patients with mental disorders and are gatekeepers to specialist care. The extent to which patients consider their primary care team as relevant to their mental health problems needs to be explored. OBJECTIVES: To explore reasons why patients choose not to disclose psychological problems to GPs, and to discuss the implications for the provision of primary mental health care. METHODS: A cross-sectional survey of consecutive patients attending general practices in New Zealand (part of the MaGPIe study). Patients were screened using the GHQ-12 and a stratified sample participated in a structured in-depth interview to assess their psychological health. Non-disclosure of psychological problems was explored. GPs assessed patients' psychological health using a 5-point scale of severity. RESULTS: Seventy GPs (90%) and 775 patients (70%) participated. Overall, 29.8% of all patients and 36.9% of patients with current symptoms reported non-disclosure of self-perceived psychological problems. Younger patients, those consulting more frequently and those with greater psychiatric disability were more likely to report non-disclosure. The most frequently given reasons were beliefs that a GP is not the 'right' person to talk to (33.8%) or that mental health problems should not be discussed at all (27.6%). CONCLUSIONS: Interventions such as screening and GP education may be ineffective in improving primary mental health care unless accompanied by educational programmes for the general public to increase mental health literacy, de-stigmatise mental illness and increase awareness of general practice as an appropriate and effective source of health care.     

Does my patient have capacity to consent to treatment?

A competent adult patient has an ethical and legal right to give or withhold consent to an examination, investigation or treatment. Depending on the nature and complexity of an intervention, a patient with a developmental disability may be capable of consenting to their own medical treatment. In circumstances in which an adult patient does not have the capacity to consent, there is specific guardianship legislation enacted in each state that provides for valid consent by a substitute decision maker.     

Illness due to work or to an overactive thyroid?

An incapacity to work brought about by stress was diagnosed in two women aged 40 and 38. They were both in conflict situations at work and had psychological problems. They stopped working but remained tired and irritable. After being unfit for work for more than a year they were diagnosed with hyperthyroidism which was treated appropriately. They both recovered and resumed work. Hyperthyroidism can impair physical and mental functioning. Presenting symptoms may be confusing, specifically if work-related factors appear to be the obvious implication. In The Netherlands, employees who become ill, consult their general practitioner or a medical specialist, who are concerned with diagnosis and treatment. They also report to their employer's occupational-health department, where the physician focuses on work-related factors that may impair health and on assessment of disability. Communication between all parties should be optimal.