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barriers to health

Kelly Ackerson, Ruth Zielinski
BACKGROUND: far too many women continue to die from pregnancy and childbirth related causes. While rates have decreased in the past two decades, some areas of the world such as sub-Saharan Africa continue to have very high maternal mortality rates. One intervention that has been demonstrated to decrease maternal mortality is use of family planning and modern contraception, yet rates of use in sub-Saharan countries with the highest rates of maternal death remain very low. AIM: to review available research and summarize the factors that inhibit or promote family planning and contraceptive use among refugee women and women from surrounding areas living in Sub-Saharan Africa...
August 1, 2017: Midwifery
Sherry Glied, Ougni Chakraborti, Therese Russo
ISSUE. Prior research shows that low-income residents of states that expanded Medicaid under the Affordable Care Act are less likely to experience financial barriers to health care access, but the impact on out-of-pocket spending has not yet been measured. GOAL. Assess how the Medicaid expansion affected out-of-pocket health care spending for low-income families compared to those in states that did not expand and consider whether effects differed in states that expanded under conventional Medicaid rules vs...
August 2017: Issue Brief of the Commonwealth Fund
Rex P K Lam, Satchit Balsari, Kevin K C Hung, Kai-Hsun Hsiao, L P Leung, Jennifer Leaning
OBJECTIVES: To assess the level of all-hazards disaster preparedness and training needs of emergency department (ED) doctors and nurses in Hong Kong from their perspective, and identify factors associated with high perceived personal preparedness. DESIGN: This study was a cross-sectional territory-wide online survey conducted from 9 September to 26 October, 2015. Participants The participants were doctors from the Hong Kong College of Emergency Medicine and nurses from the Hong Kong College of Emergency Nursing...
August 22, 2017: Disaster Medicine and Public Health Preparedness
Doreen Mukona, Stephen Peter Munjanja, Mathilda Zvinavashe, Babil Stray-Pederson
Diabetes in pregnancy contributes to maternal mortality and morbidity though it receives little attention in developing countries. The purpose of the study was to explore the barriers to adherence and possible solutions to nonadherence to antidiabetic therapy in women with diabetes in pregnancy. Antidiabetic therapy referred to diet, physical activity, and medications. Four focus group discussions (FGDs), each with 7 participants, were held at a central hospital in Zimbabwe. Included were women with a diagnosis of diabetes in pregnancy, aged 18 to 49 years, and able to speak Shona or English...
2017: Journal of Diabetes Research
Karen L Tang, Kelsey Lucyk, Hude Quan
BACKGROUND: Professional coding specialists ("coders") are experts at translating patient chart information into alphanumerical codes, which are then widely used in research and health policy decision-making. Coders rely solely on documentation by health care providers to complete this task. We aimed to explore physician-related barriers to coding that results in high-quality administrative data. METHODS: In a qualitative study conducted from December 2015 to March 2016, we recruited 28 coders who worked in health care facilities in Alberta using purposive and snowball sampling...
August 15, 2017: CMAJ Open
Oliver Razum, Katharina Reiss, Jürgen Breckenkamp, Lutz Kaufner, Silke Brenne, Kayvan Bozorgmehr, Theda Borde, Matthias David
OBJECTIVE: Research on health services for immigrants has mostly been concerned with access barriers but rarely with appropriateness and responsiveness of care. We assessed whether appropriateness and responsiveness of care depend on migration status, using provision of neuraxial anaesthesia (NA) during labour as indicator. In relation to their migration status, we analysed whether (1) women undergoing elective or secondary/urgent secondary caesarean sections (ESCS) appropriately receive NA (instead of general anaesthesia), (2) women delivering vaginally appropriately receive NA and (3) women objecting to NA, for example, for religious reasons, may deliver vaginally without receiving NA (provider responsiveness)...
August 21, 2017: BMJ Open
Leslie L Chang, Adam D DeVore, Bradi B Granger, Zubin J Eapen, Dan Ariely, Adrian F Hernandez
Behavioral challenges are often present in human illness, so behavioral economics is increasingly being applied in healthcare settings to better understand why patients choose healthy or unhealthy behaviors. The application of behavioral economics to healthcare settings parallels recent shifts in policy and reimbursement structures that hold providers accountable for outcomes that are dependent on patient behaviors. Numerous studies have examined the application of behavioral economics principles to policy making and health behaviors, but there are limited data on applying these concepts to the management of chronic conditions, such as heart failure (HF)...
August 22, 2017: Circulation
Valerie Schulz, Allison Crombeen, Denise Marshall, Joshua Shadd, Kori LaDonna, Lorelei Lingard
INTRODUCTION: Despite the recent promotion of communication guides to improve decision-making with patients nearing the end of their lives, these conversations remain challenging. Deeper and more comprehensive understanding of communication barriers that undermine discussions and decisions with patients at risk of dying from heart failure (HF) are vital for informing communication in healthcare. OBJECTIVES: To explore experiences and perspectives of patients with advanced HF, their caregivers and providers, regarding conversations for patients at risk of dying from HF...
August 4, 2017: Journal of Pain and Symptom Management
Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Meunier-Beillard, Sandrine Vinault, Uriel Leiva Rojas, Fiona Ecarnot, Sébastien Prin, Pierre-Emmanuel Charles, Isabelle Fournel, Jean-Philippe Rigaud, Jean-Pierre Quenot
BACKGROUND: Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of Advance Directives (AD) after a stay in the ICU. METHODS: Study performed from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home >3 months previously. Semi-directive interviews with patients focused on 5 main points surrounding AD...
August 4, 2017: Anaesthesia, Critical Care & Pain Medicine
Helen Richmond, Amanda M Hall, Zara Hansen, Esther Williamson, David Davies, Sarah E Lamb
OBJECTIVES: Our objectives were two-fold: (i) to describe physiotherapists' experiences of implementing a cognitive behavioural approach (CBA) for managing low back pain (LBP) after completing an extensive online training course (iBeST), and (ii) to identify how iBeST could be enhanced to support long-term implementation before scale up for widespread use. DESIGN: We conducted semi-structured interviews with 11 physiotherapists from six National Health Service departments in the Midlands, Oxfordshire and Derbyshire...
June 1, 2017: Physiotherapy
Dan T Kho, Michelle Glass, Euan S Graham
The central nervous system (CNS) is an immune privileged site where the neurovascular unit (NVU) and the blood-brain barrier (BBB) act as a selectively permeable interface to control the passage of nutrients and inflammatory cells into the brain parenchyma. However, in response to injury, infection, or disease, CNS cells become activated, and release inflammatory mediators to recruit immune cells to the site of inflammation. Increasing evidence suggests that cannabinoids may have a neuroprotective role in CNS inflammatory conditions...
2017: Advances in Pharmacology
Michael R Kilbourn
As the field of PET has expanded and an ever-increasing number and variety of compounds have been radiolabeled as potential in vivo tracers of biochemistry, transporters have become important primary targets or facilitators of radiotracer uptake and distribution. A transporter can be the primary target through the development of a specific high-affinity radioligand: examples are the multiple high-affinity radioligands for the neuronal membrane neurotransmitter or vesicular transporters, used to image nerve terminals in the brain...
September 2017: Seminars in Nuclear Medicine
Mary J Isaacson, Anna R Lynch
PURPOSE: American Indians/Alaska Natives (AIs/ANs) have higher rates of chronic illness and lack access to palliative/end-of-life (EOL) care. This integrative review ascertained the state of the science on culturally acceptable palliative/EOL care options for Indigenous persons in the United States. DESIGN: Databases searched: CINAHL, PubMed/MEDLINE, SocINDEX, PsycINFO, PsycARTICLES, ERIC, Health Source: Nursing/Academic Edition, and EBSCO Discovery Service 1880s-Present...
July 1, 2017: Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society
Ramraj Gautam, Barbara E Mawn, Sarah Beehler
PURPOSE: This study explores the experiences and adjustment process among older Bhutanese refugees resettled in the United States and identifies their unmet health and social service needs. DESIGN: This phenomenological study design included the conduction of nine in-depth semistructured interviews in the respondents' native language. The researchers adhered to the steps outlined by Moustakas for data analysis. RESULTS: The five identified themes included the following: a better life but with little sorrows, cultural tensions related to adaptation, language as a barrier to success in the United States, isolation and loneliness, and worries about citizenship and its impact on the future...
March 1, 2017: Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society
Myoungock Jang, Constance M Johnson, Gail D'Eramo-Melkus, Allison A Vorderstrasse
PURPOSE: Strategies to decrease societal and cultural barriers for ethnic minorities to participate in health research are well established. However, limited data are available regarding participation of ethnic minorities in mobile and Internet technology-based interventions to self-manage type 2 diabetes where health disparities are predominant. Thus, the purpose was to understand the participation of ethnic minorities in technology-based intervention programs to manage type 2 diabetes...
July 1, 2017: Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society
Dorthe S Nielsen, Lisbeth Minet, Lina Zeraig, Dlama Nggida Rasmussen, Morten Sodemann
PURPOSE: Older non-Western migrants in Europe are a vulnerable population, due to old age and multiple disadvantages related to language barriers and different understandings of care, health, and disease. Our aim was to gain a better understanding and insight into the care needs of families with refugee background Method: The study was designed as a qualitative exploration using semistructured individual interviews and family group interviews. RESULTS: The results illustrate how vulnerability can "transmit" from one family member to another...
July 1, 2017: Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society
Belgüzar Kara
PURPOSE: To examine health beliefs related to salt-restricted diet, to investigate their associations with demographic/disease-related characteristics and family support, and to determine the need for tailored interventions in Turkish patients on hemodialysis. METHOD: A cross-sectional study was conducted among 200 patients on hemodialysis. Data were collected through an information form, the Perceived Social Support from Family Scale and the Beliefs about Dietary Compliance Scale, including two subscales: perceived benefits and barriers...
February 1, 2017: Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society
Carolyn L Tobin, Pam Di Napoli, Cheryl Tatano Beck
The aim of this work is to synthesize qualitative research on refugee and immigrant women's experiences of postpartum depression (PPD) to gain insight into the unique needs of this group of women. This population is more at risk of developing PPD due to a complexity of issues including pre- and postmigratory stressors; however, there is currently little research on this topic available to health care providers and policy makers. Thirteen articles met inclusion criteria, and five themes emerged from the meta-synthesis: (a) suffering in solitude, (b) the invisible illness, (c) cultural conceptualizations, (d) barriers to help seeking, and (e) facilitators of help seeking...
January 1, 2017: Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society
Ninfa C Peña-Purcell, Lauren Cutchen, Traechel McCoy
INTRODUCTION: Health disparities persist among African Americans (AAs) and Latino adults with type 2 diabetes. The purpose of this research was to use PhotoVoice to examine AAs and Latinos' daily experiences of managing diabetes. METHOD: An exploratory, descriptive study using PhotoVoice and focus groups was conducted over a 3-week period: Week 1 orientation session, Week 2 photo taking and returning cameras, and Week 3 focus group to share and discuss photos. RESULTS: Ten AAs and nine Latino adults were enrolled, forming four focus groups...
March 1, 2017: Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society
Kathryn Ferguson, Judy M Bradley, Daniel F McAuley, Bronagh Blackwood, Brenda O'Neill
BACKGROUND: The REVIVE randomized controlled trial (RCT) investigated the effectiveness of an individually tailored (personalized) exercise program for patients discharged from hospital after critical illness. By including qualitative methods, we aimed to explore patients' perceptions of engaging in the exercise program. METHODS: Patients were recruited from general intensive care units in 6 hospitals in Northern Ireland. Patients allocated to the exercise intervention group were invited to participate in this qualitative study...
January 1, 2017: Journal of Intensive Care Medicine
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