Many studies have reported on issues of accessibility and quality of health care among the different vulnerable subgroups in urban locations. To date, no study has been done on the challenges faced ...by health care–seeking migrants (those traveling to cities for health reasons). This qualitative study used in-depth interviews and nonparticipant observation to examine the health problems, health care–seeking trajectories, and challenges faced by health care–seeking migrants in Delhi, India. Participants described long courses of health care seeking, typically from the district to the state capital to the national capital. There were variegated paths to health care seeking characterized by delays in service utilization, progression of disease, and cost escalation. The challenge relating to the delay in receiving health care was exacerbated by the residency status of health care–seeking migrants. In conclusion, health-related migration is associated with shared but also unique barriers to health care seeking. India’s urban health care reform agenda needs to cater to the needs of this population.
Inequalities in access to and utilization of maternal and child health (MCH) care are hampering progress on the path to achieving the Sustainable Development Goals. In a number of Low- and ...Middle-Income Countries (LMICs) population subgroups at disproportionate risk of being left behind are the urban poor. Within this neglected group is the further neglected group of the homeless. Concomitantly, a number of interventions from the antenatal period onward have been piloted, tested, and scaled in these contexts. We carried out an overview of systematic reviews (SRs) to characterize the evidence around maternal and child health interventions relevant to urban poor homeless populations in LMICs.
We searched Medline, Cochrane Library, Health Systems Evidence and EBSCOhost databases for SRs published between January 2009 and 2020 (with an updated search through November 2021). Our population of interest was women or children from urban poor settings in LMICs; interventions and outcomes corresponded with the World Health Organization's (WHO) guidance document. Each SR was assessed by two reviewers using established standard critical appraisal checklists. The overview was registered in PROSPERO (ID: CRD42021229107).
In a sample of 33 high quality SRs, we found no direct relevant evidence for pregnant and lactating homeless women (and children) in the reviewed literature. There was a lack of emphasis on evidence related to family planning, safe abortion care, and postpartum care of mothers. There was mixed quality evidence that the range of nutritional interventions had little, unclear or no effect on several child mortality and development outcomes. Interventions related to water, sanitation, and hygiene, ensuring acceptability of community health services and health promotion type programs could be regarded as beneficial, although location seemed to matter. Importantly, the risk of bias reporting in different reviews did not match, suggesting that greater attention to rigour in their conduct is needed.
The generalizability of existing systematic reviews to our population of interest was poor. There is a clear need for rigorous primary research on MCH interventions among urban poor, and particularly homeless populations in LMICs, as it is as yet unclear whether the same, augmented, or altogether different interventions would be required.
Civil Society Organisations (CSO) have played a significant role globally in improving access of under-served populations to healthcare, including the homeless. In India, while there exist ...small-scale initiatives such as night shelters and recovery shelters run by the urban local government in coordination with CSOs to support homeless people, evidence on how these services function and are experienced is lacking. This analysis sought to describe the roles played by CSOs – alone and in partnership with the government – as well as how these were experienced by homeless people. A qualitative study consisting of five Focus Group Discussions, 24 In Depth Interviews, and non-participant observation was carried out among homeless people staying in shelters and the streets in India's national capital, Delhi. Data analysis was done using a grounded theory approach with inductive generation of themes. CSOs provided various forms of support - ranging from the provision of night shelters for temporary accommodation, recovery shelters for ailing homeless people requiring support and provisional accommodation for convalescence, drinking water and sanitation, to basic health services, first aid treatment, diagnostic tests, mental health counselling, support with treatment costs, and patient navigation. Notwithstanding constraints of funding and networks that hampered continuity and comprehensiveness of care, CSOs are key in ensuring access to health services and social determinants among the urban poor; their impact and the possibility of networking and scaling up their efforts warrant further study.
•Civil Society Organisations (CSOs) deliver critical health and related services to the homeless in India.•These services lack comprehensiveness and continuity.•CSO service delivery roles must be acknowledged and studied further.
Background:
Tobacco use contributes to almost 40% of the cancers in India. Considering the potential threat, many preventive measures have been instigated in the country. However, tobacco cessation ...for hospitalized cancer patients is an unexplored territory in India. This study aims to understand the quit status and to explore the reasons to quit or continue the use of tobacco after the diagnosis of head and neck cancer (HNC).
Methods:
HNC patients admitted between February and April 2016 were assessed for their tobacco use status. A DT was used to assess the psychological distress. Users were assessed for their readiness to quit and dependence on tobacco. An in-depth interview was conducted among 25 patients (seven current users and 18 recent quitters), and themes that emerged were discussed.
Results:
Of the 119 HNC patients, 71 were tobacco users and 48 had quit tobacco after the diagnosis. The reasons to quit were the perceived benefits of quitting, advice from the physicians, and awareness about cancer and its association with tobacco. In contrast, the reasons to continue the use of tobacco were attributed to coping mechanisms, nihilistic perception about the outcome of the cancer, and a lack of understanding about cancer and its association with tobacco.
Conclusion:
The recent quitters comprehended the benefits of quitting and were able to prioritize their needs after the diagnosis. However, one-third of the HNC patients continued to use tobacco even after the diagnosis of cancer. Hence, tobacco cessation services need to be integrated into oncology services for achieving better treatment outcomes.
Medical Professionalism (MP) defined as values, behaviours and attitudes that promote professional relationships, public trust and patient safety is a vital competency in health profession education. ...MP has a distinctive uniqueness due to cultural, contextual, conceptual, and generational variations. There is no standard instructional strategy to probe the understanding of MP in a cohesive, structured, interactive manner. This study aimed to investigate undergraduate medical students' understanding of MP using express team-based learning (e-TBL) at both campuses of Royal College of Surgeons Ireland (RCSI). Using the key principles of a sociocultural theoretical lens in adult learning theory, we designed e-TBL as a context-learning-based educational strategy. We conducted three e-TBL sessions on cross-cultural communication and health disparities, a reflective report on clinical encounters, and professionalism in practice. We collected, collated, and analyzed the student experiences qualitatively using data gathered from team-based case discussions during e-TBL sessions. A dedicated working group developed very short-answer questions for the individual readiness assurance test (IRAT) and MP-based case scenarios for team discussions. In this adapted 4-step e-TBL session, pre-class material was administered, IRAT was undertaken, and team-based discussions were facilitated, followed by facilitator feedback. A qualitative inductive thematic analysis was performed, which generated subthemes and themes illustrated in excerpts. Our thematic analysis of data from 172 students (101 from Bahrain and 71 from Dublin) yielded four unique themes: incoming professional attitudes, transformative experiences, sociological understanding of professionalism, and new professional identity formation. This qualitative study provides a deeper understanding of medical students' perceptions of medical professionalism. The generated themes resonated with divergent and evolving elements of MP in an era of socioeconomic and cultural diversity, transformative experiences, and professional identity formation. The core elements of these themes can be integrated into the teaching of MP to prepare fit-to-practice future doctors.
John 13,1 is generally recognized as one of the most important verses in the overall structure of the Fourth Gospel. However, its syntax is very difficult and disputed among interpreters. The complex ...nature of this verse resulted in different ways of translating it (for instance, the NIV, RSV and NRSV). The main problem of this verse is determining which verb is qualified by the prepositional phrase, πρò δὲ τη̅ς ὲ ορτη̅ς τοû πάσχα. This study investigates the complex syntax of John 13,1, defending the reading of the prepositional phrase with ήγάπησβν and understanding the participial constructions (εἰδώç and άγαπήσας) as circumstantial participles.
The purpose of this study is to understand the linkages between natural disasters and their impact on the mental health of people as well as associated resilience mechanisms in India. Natural ...disasters affect not only the physical environment but also the economy, social life, and well-being of the population. In addition to the loss of precious lives and economic losses, disasters affect the natural growth and mental health of the affected populations to a great extent. It is extremely challenging to quantify the true scale of damage caused by a disaster because physical damage is visible, but hidden impacts could be much more severe and have catastrophic effects on the socioeconomic growth of the affected families and areas. Against this background and with the limited available evidence, this study has tried to understand how disasters lead to poor mental health among the affected populations around the globe and tried to conceptualize this in the Indian context. Our review documents the different pathways for disasters to adversely affect mental health, particularly among vulnerable populations. The review also highlights how an increased frequency of disasters with climate change can lead to a post-traumatic stress disorder, adjustment disorder, and depression. Changes in climate and global warming may require populations to migrate, which can lead to acculturation stress. It can also lead to increased rates of physical illnesses, which secondarily would be associated with psychological distress. This research is an initial step in bringing this important issue forward in the context of Sustainable Development Goals and outlining that better policies need to be designed for prevention, services, and psychological counseling of mental health problems due to disasters. This study also suggests for more longitudinal research to understand the development of disaster-related mental health problems and to develop adequate mitigation strategies.
Mystery of perinatal outcomes by COVID-19 Das, V. K.; Pandya, Kaveri; Mathew, Bincy ...
International Journal Of Community Medicine And Public Health,
07/2021, Letnik:
8, Številka:
8
Journal Article
Background: The coronavirus disease is continuously affecting the lives of all people and it has grown into a pandemic. Understanding the impact of COVID-19 on pregnancy in terms of morbidity, ...mortality as well as perinatal-maternal and foetal outcomes is essential to propose strategies for prevention and infection control. In this study, an attempt has been made to assess the impact of COVID-19 on perinatal outcomes.Methods: It was a retrospective analytical study. The case-files of 47 antenatal mothers who were RT-PCR positive & delivered during the course of treatment were taken for the study.Results: Out of all samples, 91.49% were asymptomatic, 10.63% had pregnancy induced hypertension (PIH) as comorbidity, 88.10% had anaemia, 40.43% had WBC count more than 10,000/mm3. 97.87 % of the samples recovered from COVID-19 with routine obstetrical management and only one case was kept on BIPAP support. Perinatal complications like preterm deliveries (27.66%), foetal distress (27.66%), NRNST (19.15%), PROM (4.26%), decreased foetal movement (2.13 %), LBW (6.38%), APGAR<7 at 5 min (15.55%), still birth (4.26%), NICU admission (31.11%), neonatal death (2.13%) were identified. 68.89% neonates were breastfed. The RT-PCR of all neonates came negative on first day of delivery which indicates that there was no vertical transmission. In this study, the results show that the perinatal outcomes are mildly affected by COVID-19.Conclusions: Although COVID-19 doesn’t directly affect perinatal outcomes, it has indirect adverse effects on MCH services. Hence, emergency obstetric and neonatal care is an essential service to be continued with awareness of people while maintaining social distancing and personal hygiene.
Psychological distress is often an under-diagnosed problem in cancer care. Addressing psychosocial issues would enhance treatment compliance, physician-patient relationship, treatment efficacy and ...quality of life. This article emphasizes the importance of integrating psycho-oncology services in cancer care and attempts to define the various roles that a psycho-oncologist can play across the entire trajectory. It also highlights the indispensable role played by the oncologists' referrals in maximizing the benefits of psycho-oncology services received by patients and their caregivers.
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