Association Between Maternal Education and Childhood Mortalities in Myanmar

Maternal education is widely regarded as a core social determinant of child mortality in low-income countries. In Myanmar, the evidence related to context-specific social determinants of health including maternal education is scarce, limiting grounds to advocate for a comprehensive health policy. Employing multivariate methods, the study analyzed the 2015-2016 Demographic Health Survey data exploring independent effect of maternal education on neonatal, infant, and under-5 mortality. The study found that maternal education was not significantly associated with neonatal mortality as its effect was confounded by household wealth and geographic residence; however, it had independent effect on infant and under-5 mortality. Mothers with primary education had 23% reduction in the odds of under-5 mortality (P < .001); those with secondary level had 40% reduction (P < .001); and those at higher level had 62% reduction (P < .001). The study concluded that maternal education is a critical social determinant of childhood mortalities in Myanmar

Labour market preferences, attitudes and expectations of prospective health workers in Guinea

Background: This study identifies the stated attitudes, expectations, and locational job preferences (and factors influencing these preferences), of final year medical and nursing students in Guinea, West Africa. Such evidence can help design interventions that influence the supply side behaviour of graduates, and thus improve the availability and distribution of health workers in Guinea. Methods: The study uses a nationally representative cross-sectional survey design to sample 193 and 192 final year nursing and medical students, respectively, from across medical and nursing schools in Guinea. Percentage analysis and statistical tests were applied to explore differences in attitudes, expectations and locational preferences of medical and nursing students. Binary logistic regression was applied to identify predictors of the stated locational outcome variables (i.e. Conakry/outside Conakry, rural/urban, public/private, and national/abroad preferences of the health students). Results: The stated attitudes and expectations, in terms of working in the health labour market, differ for medical and nursing students in Guinea. For example, whereas both medical and nursing students expect to find good working conditions once posted, significantly more medical than nursing students expect to be posted into a job within 6 months of graduating, earn more from informal income generation activities, and find it acceptable to earn extra income during working hours and work less hours than stated in their contract. In terms of locational preferences, overall there is a strong short-term preference to work outside of Conakry, in urban locations, in the private sector, and to migrate abroad. The extent of these preferences varies between medical and nursing students, some of which change in the medium term, and are explained by a number of stated monetary and non-monetary factors, and statistically associated with and number of predictor variables that mostly vary between medical and nursing students. Conclusions: The study confirms the existing heterogeneity of attitudes, expectations and locational labor market preferences of medical and nursing students. There is a need for different education and labor market interventions, to mitigate unmet expectations and potentially disruptive attitudes, and to increase job uptake particularly in rural areas and to reduce migration abroad. The design of such interventions should take into account the different monetary and non- monetary, education and profile related factors that are influencing the supply side preference of medical and nursing students in Guinea

Self-efficacy of older people using technology to self-manage COPD, hypertension, heart failure or dementia at home:An overview of systematic reviews

Background and Objectives Although telehealth research among the general population is voluminous, study quality is low and results are mixed. Little is known specifically concerning older people and their self-efficacy to engage with and benefit from such technologies. This paper reviews the evidence for which self-care telehealth technology supports the self-efficacy of older people with long-term conditions (LTCs) living at home. Research Design and Methods Following PRISMA guidelines, this overview of systematic reviews focused on four LTCs and the concept of ‘self-efficacy’. Quality was appraised using R-AMSTAR and study evaluation was guided by the PRISMS taxonomy for reporting of self-management support. Heterogeneous data evidencing technology-enhanced self-efficacy were narratively synthesised. Results Five included papers contained 74 primary studies involving 9,004 participants with chronic obstructive pulmonary disease (COPD), hypertension, heart failure or dementia. Evidence for self-care telehealth technology supporting self-efficacy of older people with LTCs living at home was limited. Self-efficacy was rarely an outcome, also attrition and drop-out rates and mediators of support or education. The pathway from telehealth to self-efficacy depended on telehealth modes and techniques promoting healthy lifestyles. Increased self-care and self-monitoring empowered self-efficacy, patient-activation or mastery. Discussion and Implications Future research needs to focus on the process by which the intervention works and the effects of mediating variables and mechanisms through which self-management is achieved. Self-efficacy, patient-activation, and motivation are critical components to telehealth’s adoption by the patient, and hence to the success of self-care in self-management of LTCs. Their invisibility as outcomes is a limitation

Road traffic accidents and self-reported Portuguese car driver's attitudes, behaviours and opinions:are they related?

Objective: This study aims to characterize Portuguese car drivers in terms of demographic characteristics, driving experience, and attitudes, opinions and behaviours concerning road traffic safety. Furthermore, associations between these characteristics and self-reported involvement in a road traffic accident as a driver in the last three years were analysed. A final goal was to develop a final predictive model of the risk of suffering a road traffic accident. Methods: A cross-sectional analytic study was developed, based on a convenience sample of 612 car drivers. A questionnaire was applied by trained interviewers, embracing various topics related to road safety such as driving under the influence of alcohol or drugs, phone use while driving, speeding, use of advanced driver assistance systems and the transport infrastructure and environment (European Project SARTRE 4, Portuguese version). From the 52 initial questions, 19 variables were selected through principal component analysis. After that, and in addition to the usual descriptive measures, logistic binary regression models were used in order to describe associations and to develop a predictive model of being involved in a road traffic accident. Results: From the 612 car drivers, 37.3% (228) reported being involved in a road traffic accident with damage or injury in the past three years. In this group, the majority were male, older than 65, with no children, not employed and living in an urban area. In the multivariate model, several factors were identified: being widowed (vs. single) (OR = 3.478, CI95%: 1.159‒10.434); living in a suburban area (vs. a rural area) (OR = 5.023, CI95%: 2.260‒11.166); having been checked for alcohol once in the last three years (vs. not checked) (OR = 3.124, CI95%: 2.040‒4,783); and seldom drinking an energetic beverage such as coffee when tired (vs. always do it) (OR = 6.822, CI95%: 2.619‒17.769) all suffered a higher risk of being involved in a car accident. Conclusions: The results obtained with regard to behavioural factors meet the majority of the risk factors associated with car accidents referred to in literature. This study highlights the relation of relatively minor accidents (the majority with no injuries) with urban (or semi-urban) context and involving older drivers. These accidents are not usually the focus of road safety literature (mainly death and serious health loss) but, additionally to the economic costs involved, they can have a huge impact on road safety (e.g., pedestrian). Specifically the following interventions can be proposed: more detailed clinical examinations to identify real competencies to drive especially in older drivers (active aging can constitute a new challenge in road safety and new paradigms can arise); education campaigns in how to cope with fatigue. Future studies in large samples and not based on self-reported behaviours should be developed

Tackling LGBTQ+ youth mental health inequality:Mapping mental health support across the UK

Young people who identify as lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) experience higher rates of mental health distress than reported in the general population, yet are far less likely to seek support services. Factors such as homophobia, biphiobia and transphobia, cis-heteronormativity, fear of judgement and lack of staff awareness of LGBTQ+ identities are barriers to help seeking. This paper reports on the first stage of a study that investigated and mapped current LGBTQ+ youth specific mental health service provision across the UK. An online and offline service mapping exercise was undertaken to identify services. 111 services were identified across the search strategies, the majority in urban settings in England. There were three significant characteristics of LGBTQ+ child and adolescent mental health UK provision. Firstly, there was an absence of mainstream NHS support that specifically addressed the needs of LGBTQ+ young people. Secondly, the majority of LGBTQ+ youth mental health support was provided by voluntary/community organisations. Thirdly, there was a new emerging model of service that is based on collaborative working between NHS trusts and community/voluntary organisations. The results of this mapping exercise suggest that there is a reliance on the voluntary/community sector to provide mental health provision for LGBTQ+ young people. Furthermore, there was a distinct divergence in the approaches of the support provided by the voluntary/community sector and those from within the NHS. The affirmation of LGBTQ+ identities that is pivotal to the support provided by voluntary/community services contrasted with the ‘treating everyone the same’ approach prevalent in mainstream service provision. NHS mental health services must recognise that to tackle LGBTQ+ youth mental health inequality, statutory mental health support must address specifically the mental health needs of LGBTQ+ young people

The role of combinatorial health technologies in supporting older people with long-term conditions:Responsibilisation or co-management of healthcare?

Neoliberalism, austerity and health responsibilisation are increasingly informing policies and practices designed to encourage older patients to take responsibility for the management of their own healthcare. Combined with an ageing population, novel ways to address the increasing healthcare needs of older people have become a priority, with the emergence in recent years of new models of integrated care enhanced by combinatorial health technologies (CHTs). This paper presents qualitative findings from the evaluation of one programme, the Lancashire and Cumbria Innovation Alliance (LCIA) Test Bed, a programme funded by NHS England and conducted in England between 2016 and 2018. Drawing on data from patients, family carers, and staff members involved in the programme, this paper explores the extent to which CHTs, as part of the LCIA Test Bed programme, contributed to health responsibilisation amongst older people with complex health conditions. Through this programme, we find that relationships between patients, family carers and healthcare professionals combined to create a sense of reassurance and shared responsibility for all parties. Our findings suggest the need for a more nuanced approach to responsibilisation and self-management for older people living with complex health conditions. By focusing on co-management – and recognising the potential of CHTs to facilitate this approach – there is potential to increase patient confidence in managing their health condition, reduce carer burden, and enhance clinician satisfaction in their work roles. While neoliberal agendas are focused on self-management and self-responsibility of one’s own health care, with technology as a facilitator of this, our findings suggest that the successful use of CHTs for older people with complex health conditions may instead be rooted in co-management. This paper argues that co-management may be a more successful model of care for patients, carers and clinicians

The specification, acceptability and effectiveness of respite care and short breaks for young adults with complex healthcare needs: protocol for a mixed-methods systematic review

IntroductionThe number of young adults with complex healthcare needs due to life-limiting conditions/complex physical disability has risen significantly as children with complex conditions survive into adulthood. Respite care and short breaks are an essential service, however, needs often go unmet after the transition to adult services, leading to a significant impact on the life expectancy and quality of life for this population. We aim to identify, appraise and synthesise relevant evidence to explore respite care and short breaks provision for this population, and to develop a conceptual framework for understanding service models.Methods and analysisA mixed-methods systematic review conducted in two stages: (1) knowledge map and (2) evidence review. We will comprehensively search multiple electronic databases; use the Citations, Lead authors, Unpublished materials, Google Scholar, Theories, Early examples, and Related projects (CLUSTER) approach, search relevant websites and circulate a ‘call for evidence’. Using the setting, perspective, intervention/phenomenon of interest, comparison and evaluation framework, two reviewers will independently select evidence for inclusion into a knowledge map and subsequent evidence review, extract data relating to study and population characteristics, methods and outcomes; and assess the quality of evidence. A third reviewer will arbitrate where necessary.Evidence will be synthesised using the following approaches: quantitative (narratively/conducting meta-analyses where appropriate); qualitative (framework approach); policy and guidelines (documentary analysis informed approach). An overall, integrated synthesis will be created using a modified framework approach. We will use Grading of Recommendations Assessment, Development and Evaluation (GRADE)/GRADE-Confidence in the Evidence from Reviews of Qualitative Research to assess the strength and confidence of the synthesised evidence. Throughout, we will develop a conceptual framework to articulate how service models work in relation to context and setting.Ethics and disseminationEthical approval is not required as this is a systematic review. We will present our work in academic journals, at appropriate conferences; we will disseminate findings across networks using a range of media. Steering and advisory groups were established to ensure findings are shared widely and in accessible formats.PROSPERO registration numberCRD42018088780

The economic burden experienced by carers of children who had a critical deterioration at a tertiary children’s hospital in the United Kingdom (the DETECT study): an online survey

BackgroundUnplanned critical care admissions following in-hospital deterioration in children are expected to impose a significant burden for carers across a number of dimensions. One dimension relates to the financial and economic impact associated with the admission, from both direct out-of-pocket expenditures, as well as indirect costs, reflecting productivity losses. A robust assessment of these costs is key to understand the wider impact of interventions aiming to reduce in-patient deterioration. This work aims to determine the economic burden imposed on carers caring for hospitalised children that experience critical deterioration events.MethodsDescriptive study with quantitative approach. Carers responded to an online survey between July 2020 and April 2021. The survey was developed by the research team and piloted before use. The sample comprised 71 carers of children admitted to a critical care unit following in-patient deterioration, at a tertiary children's hospital in the UK. The survey provides a characterisation of the carer's household and estimates of direct non-medical costs grouped in five different expenditure categories. Productivity losses can also be estimated based on the reported information.ResultsMost carers reported expenditures associated to the child's admission in the week preceding the survey completion. Two-thirds of working carers had missed at least one workday in the week prior to the survey completion. Moreover, eight in ten carers reported having had to travel from home to the hospital at least once a week. These expenditures, on average, amount to £164 per week, grouped in five categories (38% each to travelling costs and to food and drink costs, with accommodation, childcare, and parking representing 12%, 7% and 5%, respectively). Additionally, weekly productivity losses for working carers are estimated at £195.ConclusionUnplanned critical care admissions for children impose a substantial financial burden for carers. Moreover, productivity losses imply a subsequent cost to society. Even though subsidised hospital parking and on-site accommodation at the hospital contribute to minimising such expenditure, the overall impact for carers remains high. Interventions aiming at reducing emergency critical care admissions, or their length, can be crucial to further contribute to the reduction of this burden.Trial registrationCurrent Controlled Trials ISRCTN61279068, date of registration 07/06/2019, retrospectively registered

Position Paper - Os Desafios da Reavaliação de Tecnologias de Saúde em Portugal

Introduction: The recently created Health Technology Assessment System (SiNATS) in Portugal will allow the reassessment of health technologies in a clinical practice context. This position paper intends to list and briefly describe the numerous challenges and limitations that may influence the premises and the Outcomes of the health technology reassessments and therefore its own purpose. This paper reflects the position adopted by the ISPOR Portugal Regional Chapter (International Society for Pharmacoeconomics and Outcomes Research – ISPOR Portugal) regarding this subject. Methods: A group of members of ISPOR Portugal reviewed the literature available, namely documents of international workgroups that have previously focused on similar matters, and conducted a critical analysis on the challenges faced by health technologies reassessment within the national context. A final revision of the paper was requested to all members of the ISPOR Portugal Regional Chapter. Results: Several limitations that may potentially compromise the reassessment of health technologies have been identified and thoroughly described, namely those with regard to the intervention itself (i.e. the health technology), the study population, the selection of the comparator and the Health Outcomes to consider in this type of analysis. The relevance of the information sources on which the investigation of comparative effectiveness may rely upon (at least to some extent) as well as the limitations and flaws inherent to it (i.e. bias and confounding factors) were also highlighted. Conclusions: A health technology reassessment system must be subject to an a priori analysis regarding its potentialities and limitations. In this paper these issues are addressed while taking SiNATS’s goals as reference points. Nevertheless, it is necessary to give continuity to this work, particularly through the creation of workgroups whose purpose is to study and analyse with greater detail the matters mentioned herein. Such work may, in fact, prove to be crucial for a successful implementation of a reassessment system that makes fair and efficient decisions on the funding of health technologies in Portugal