Exploring the impacts of organisational structure,policy and practice on the health inequalities of marginalised communities: Illustrative cases from the UK healthcare system

This paper explores how organisational structure, policies and practices in healthcare can inadvertently disadvantage marginalised populations (e.g. individuals from ethnic minority backgrounds) and reinforce health inequalities. We draw upon three diverse UK healthcare settings (long term care institutions, high security hospitals and community pharmacies) to illustrate how systemic injustices negatively impact on access to care, treatment and health outcomes. The first case study considers the care of older people within nursing homes; specifically the disempowering effects of this service structure and impacts of choice reduction upon health and their access to health provision. The second case study explores the impact of security restrictions upon patients within high security hospitals, focusing particularly on the maintenance of relationships and support networks outside of the hospital. The third and final case study, draws upon a national community pharmacy medicine management service to illustrate ways in which policies and guidelines inadvertently obstruct patients' engagement with the service within a community setting. We draw upon these settings to highlight inequalities within different contexts and to illustrate the ways in which well intended services can inadvertently disadvantage marginalised communities in multiple ways.     

Implementation of Recommendations for Long-Acting Contraception Among Women Aged 13 to 18 Years in Primary Care

ObjectiveClinical specialty societies recommend long-acting reversible contraceptives (LARCs) as first-line contraception for adolescent women. We evaluated whether a combined educational and process improvement intervention enhanced LARC placement in primary care within an integrated health care system.MethodsThe intervention included journal clubs, live continuing education, point-of-care guidelines, and new patient materials. We conducted a retrospective cohort study across 3 time periods: baseline (January 2013?September 2015), early implementation (October 2015–March 2016), and full implementation (April 2016–June 2017). The primary outcome was the proportion of LARCs placed by primary care clinicians among women aged 13 to 18 years compared with gynecology clinicians.ResultsKaiser Foundation Health Plan of Colorado cared for approximately 20,000 women aged 13 to 18 years in each calendar quarter between 2013 and 2017. Overall, LARC placement increased from 7.0 per 1000 members per quarter at baseline to 13.0 per 1000 during the full intervention. Primary care clinicians placed 6.2% of all LARCs in 2013, increasing to 32.1% by 2017 (P < .001), including 45.5% of contraceptive implants. Clinicians who attended educational sessions were more likely to adopt LARCs than those who did not (17.9% vs 6.4% respectively, P = .009). Neither overall LARC placement rates (relative risk, 1.9; 95% confidence interval, 0.7?5.6) nor contraceptive implant rates (relative risk, 3.0; 95% confidence interval, 0.9?9.8) increased significantly in clinicians who attended educational activities.ConclusionsThis multimodal intervention was associated with increased LARC placement for adolescent women in primary care. The combination of education and process improvement is a promising strategy to promote clinician behavior change.     

The combined relations of gender,enculturation, and depressive symptoms with health risk behaviors in Mexican-Americans: a moderated mediation analysis

ABSTRACT

Objectives: The present study investigated the relationships of enculturation and depressive symptoms with health risk behavior engagement in Mexican-American college students and examined how these relationships differed by gender. Previous research has noted consistent gender differences in health risk behavior (e.g. alcohol use, substance use, and risky sexual behavior) among Latina/os, and emphasized the role of U.S. acculturation in this difference. Research examining the role of heritage cultural retention (i.e. enculturation), and including the added influence of mental health variables, such as depressive symptoms, is currently lacking. This study sought to address this gap.

Design: A large sample (N?=?677) of Mexican-American college students from four universities (located in New York, California, Florida, and Texas) completed an online questionnaire assessing health risk behaviors and corresponding variables.

Results: We found that males who endorsed more behavioral enculturation and depressive symptoms were more likely to engage in health risk behavior than all others in the sample. Contrary to previous literature, no relationship was found between behavioral enculturation and health risk behavior in females.

Conclusion: The current study found behavioral enculturation to be associated with depressive symptoms, and in turn with health risk behaviors among the males in our sample. Additional research will be needed to identify the mechanism underlying the relationship between enculturation and depressive symptoms as well as between depressive symptoms and risky behavior.     

广东省家庭医生式服务试点地区居民健康行为及影响因素分析

目的了解广东省家庭医生式服务试点地区居民健康行为及影响因素,为开展健康教育提供依据。方法2015年7—10月抽样选取1010名家庭医生式服务试点地区居民进行问卷调查,以吸烟、饮酒、早餐、吃水果、锻炼及睡眠等6项行为为调查内容,同时选用P-CAT量表测量基层医疗服务质量。结果 6项行为方式共赋值12分,被调查者平均得分(8.72?0.65)分,得分从高到低依次为吃早餐、限酒、不吸烟、体育锻炼、吃水果和睡眠。多重线性回归分析结果显示:女性、已婚或慢性病患者的健康行为优于各对应组;收入对健康行为有正面影响;基层医疗服务可及性、服务提供综合性对健康行为有正向影响。结论试点地区居民整体健康行为较好。健康教育和健康促进应聚焦于合理膳食、锻炼及睡眠等健康行为;男性、单身或离异及低收入群体是重点关注的对象;提高基层医疗服务可及性和服务提供综合性有利于促进居民的健康行为。     

Tanzania IR Initiative: Training the First Generation of Interventional Radiologists

Despite a population of nearly 60 million, there is currently not a single interventional radiologist in Tanzania. Based on an Interventional Radiology (IR) Readiness Assessment, the key obstacles to establishing IR in Tanzania are the lack of training opportunities and limited availability of disposable equipment. An IR training program was designed and initiated, which relies on US-based volunteer teams of IR physicians, nurses, and technologists to locally train radiology residents, nurses, and technologists. Preliminary results support this strategy for addressing the lack of training opportunities and provide a model for introducing IR to other resource-limited settings.     

Development of a Pilates Teaching Framework from an international survey of teacher practice

ObjectivePilates is used increasingly in a variety of clinical settings. However, there is lack of clarity in the literature as to what is meant by the term. Teachers incorporating apparatus based on the designs of Joseph Pilates (1883–1967) into their practice refer to themselves as Comprehensive Teachers, and this group divides itself further into Classical and Contemporary practice. The aim of this research was to explore the meanings of these terms with Comprehensive Teachers and to develop a framework that reflects current views and practice.MethodOnline international survey of Pilates Teachers through closed Facebook forums. Open questions were used to elicit views of the definition and practice of Pilates, and how standards should be set across the sector.ResultsOf 109 participants, 35% were based in the UK and 32% in the USA; 48% identified as Classical teachers, 32% as Contemporary, 5% as both and 15% as Matwork instructors. A thematic analysis of the qualitative data revealed agreement on the scope and content of Classical and Contemporary Comprehensive Pilates, however the discourse indicated there might be stereotyping about each other's practice. Classical teachers, for example, spoke of their own practice as authentic while Contemporary teachers used terms such as strict and inflexible for Classical practice. However, members of either group may incorporate both Classical and Contemporary approaches within their practice. We have designed a Pilates Teaching Framework to take into account the types of apparatus, the types of exercises and the order in which the exercises are executed.ConclusionsA framework that emphasises Pilates teaching rather than teacher practice is proposed for consistency and clarity when describing Pilates in professional and public contexts.     

The Geriatrician: The Frontline Specialist in the Treatment of COVID-19 Patients

On February 20, 2020, a man living in the north of Italy was admitted to the emergency room with an atypical pneumonia that later proved to be COVID-19. This was the trigger of one of the most serious clusters of COVID-19 in the world, outside of China. Despite aggressive restraint and inhibition efforts, COVID-19 continues to increase, and the total number of infected patients in Italy is growing daily. After 6 weeks, the total number of patients reached 128,948 cases (April 5, 2020), with the higher case-fatality rate (15,887 deaths) dominated by old and very old patients.This sudden health emergency severely challenged the Italian Health System, in particular acute care hospitals and intensive care units. In 1 hospital, geriatric observation units were created, the experience of which can be extremely useful for European countries, the United States, and all countries that in the coming days will face a similar situation.     

DRG支付方式改革下医院财务管理应对策略

通过探讨DRG支付方式改革下医院财务管理的应对策略,可以有效地降低医疗支付方式改革对医院财务管理的负面影响,促使医院财务管理在"危"与"机"的转换中抢抓机遇,促进医院财务管理提质增效。