Health-related Quality of Life of Deaf and Hard of Hearing Adults and Issues Related to Use of and Access to Health Services

Aim: Exploring the issues related to the use of and access to health services by the deaf and hard of hearing adults in Greece and the assessment of their health-related quality of life. Method: A cross-sectional study was conducted between 1 April 2015 and 31 June 2015. The study population consisted of 237 adults, aged 18-65 that live in Attica (86 deaf, 54 hard of hearing and 97 hearing people), sampled by the convenience sampling technique. Data collection concerning the use and access to health services of the deaf and hard of hearing, was made using a questionnaire that was specially developed for this study, based on the relevant literature. The assessment of the quality of life of all participants was conducted via the Greek version of the SF-36v2. Statistical analysis included x² test, x² test for trend, t-test, Mann-Whitney, analysis of variance, Kruskal-Wallis, Pearson correlation coefficient, Spearman correlation coefficient and multivariate linear regression. Results: Among the 86 deaf, 79 (91.9 %) were sign language users (Deaf) and 7 (8.1 %) were not. Among the 54 hard of hearing, 11 (20.4 %) were able to communicate through the spoken word, 27 (50 %) through cheileanagnosis and 16 (29.6 %) through the Greek Sign Language. The deaf were unmarried (p=0,006), didn’t live with anyone hearing (p=0,002), had a lower educational level (p<0,001), were unemployed (p<0,001), had a lower median annual family income (p<0,001) and were overweight and obese (p=0,004) at higher rates compared to the hard of hearing and hearing people. Compared to the hearing, the deaf and hard of hearing used to smoke a greater median number of cigarettes daily (p<0,001), had acquired the smoking habit for a greater median number of years (p=0,01), were drinking quantities of alcohol in a greater median per week and exercised physically in a lower median number of hours per week (p<0,001). Regarding the use of health services the last 12 months, the deaf were more often ill than the hard of hearing (p=0,02) and they visited a public hospital to cope with their illness(p=0,002). Whilst the exorbitant fees charged for a visit in the private health sector (p=0,01) were a valid complaint, the long waiting time in order to make an appointment (p=0,003) and the small interpreter availability on the appointment day (p=0,001), resulted in them visiting a private physician/clinic. Also, they considered the existence of an attendant who would help in communicating with the physician/hospital very important (p<0,001) and they preferred a GSL interpreter for their accompaniment (p<0,001). This provided a new source of complaint due to the small number of interpreters, the lack of availability and the absence of permanent interpreters in hospitals (p<0,001). Furthermore, they complained of the lack of: equipment for the deaf (p=0,01), 24h emergency center for communication with SMS (p<0,001), non-existence of ambulance personnel who can communicate via Greek Sign Language (p<0,001) and non-existence of persons in hospitals who can communicate in Greek Sign Language (p<0,001). On the other hand, the hard of hearing visited a private physician/clinic more often during the last 12 months (p=0,02), they preferred a family member to accompany them to the doctor (p <0,001) and had trouble understanding the doctor's instructions (p=0,002) at higher rates than the deaf. Regarding the access to health services, the deaf, at higher rates compared to the hard of hearing, did not know where to go (p=0,002), could not make appointments because they did not have anyone to help them (p<0,001), they could not afford the long waiting time for an appointment (p=0,01), there was a lack of available interpreters (p<0,001) and they preferred making interpretation hours saving (p<0,001). They also had a higher degree of difficulty in making an appointment to visit a doctor/ hospital comparing to the hard of hearing (p<0,001) and said that if their communication was easier they would arrange health appointments more often (p<0,001). Moreover, they did not receive the necessary medication (p<0,001), with main causes the disability to pay for the cost because of lack of prescription and the sense of self-esteem that he/she does not need it (p=0,02). According to the results of the multivariate analysis, determinants of quality of life, was the degree of hearing loss (almost in all scores of SF-36v2, except general health score), body mass index (almost in all scores of SF- 36v2, except bodily pain), the educational level (in physical function scores, physical role, bodily pain, general health, social functioning, physical health summary scale), physical activities (in physical function scores, general health, emotional role and physical health summary scale score), alcohol consumption (almost in all scores of SF-36v2, except for social functioning score), while the number of family individuals were determinant in physical health summary scale score. We also performed bivariate correlations between the independent variables of use and access to health services and the physical and mental health summary scale scores of the deaf, to investigate which of these were associated with the lowest scores that they had in the SF-36v2. Conclusions: In Greece, people with hearing disability are the most invisible citizens, systematically absent from health policy and planning, while there is a marked tendency for global efforts aimed on improving their quality of life. In the Greek health system a special effort must be made so as to achieve significant improvements and in order for an organized health service network to exist, accessible for the deaf and hard of hearing and ensuring thus the provision of adequate health care for long-term improvement of health outcomes of this population

Conceptual Model of Hearing Health Inequalities (HHI Model): A Critical Interpretive Synthesis

From SAGE Publishing via Jisc Publications RouterHistory: received 2020-06-13, rev-recd 2020-12-29, accepted 2021-02-25, epub 2021-05-28Publication status: PublishedFunder: NIHR Manchester Biomedical Research Centre; Grant(s): Award Reference NIHR-INF-0551 to DTHearing loss is a major health challenge that can have severe physical, social, cognitive, economic, and emotional consequences on people’s quality of life. Currently, the modifiable factors linked to socioeconomic inequalities in hearing health are poorly understood. Therefore, an online database search (PubMed, Scopus, and Psych) was conducted to identify literature that relates hearing loss to health inequalities as a determinant or health outcome. A total of 53 studies were selected to thematically summarize the existing literature, using a critical interpretive synthesis method, where the subjectivity of the researcher is intimately involved in providing new insights with explanatory power. The evidence provided by the literature can be summarized under four key themes: (a) There might be a vicious cycle between hearing loss and socioeconomic inequalities and lifestyle factors, (b) socioeconomic position may interact with less healthy lifestyles, which are harmful to hearing ability, (c) increasing health literacy could improve the diagnosis and prognosis of hearing loss and prevent the adverse consequences of hearing loss on people’s health, and (d) people with hearing loss might be vulnerable to receiving low-quality and less safe health care. This study uses elements from theoretical models of health inequalities to formulate a highly interpretive conceptual model for examining hearing health inequalities. This model depicts the specific mechanisms of hearing health and their evolution over time. There are many modifiable determinants of hearing loss, in several stages across an individual’s life span; tackling socioeconomic inequalities throughout the life-course could improve the population’s health, maximizing the opportunity for healthy aging

Association between patient factors and the effectiveness of wearable trackers at increasing the number of steps per day among adults with Cardiometabolic conditions: meta-analysis of individual patient data from randomized controlled trials.

Background Current evidence supports the use of wearable trackers by people with cardiometabolic conditions. However, as the health benefits are small and confounded by heterogeneity, there remains uncertainty as to which patient groups are most helped by wearable trackers. Objective This study examined the effects of wearable trackers in patients with cardiometabolic conditions to identify subgroups of patients who most benefited and to understand interventional differences. Methods We obtained individual participant data from randomized controlled trials of wearable trackers that were conducted before December 2020 and measured steps per day as the primary outcome in participants with cardiometabolic conditions including diabetes, overweight or obesity, and cardiovascular disease. We used statistical models to account for clustering of participants within trials and heterogeneity across trials to estimate mean differences with the 95% CI. Results Individual participant data were obtained from 9 of 25 eligible randomized controlled trials, which included 1481 of 3178 (47%) total participants. The wearable trackers revealed that over the median duration of 12 weeks, steps per day increased by 1656 (95% CI 918-2395), a significant change. Greater increases in steps per day from interventions using wearable trackers were observed in men (interaction coefficient -668, 95% CI -1157 to -180), patients in age categories over 50 years (50-59 years: interaction coefficient 1175, 95% CI 377-1973; 60-69 years: interaction coefficient 981, 95% CI 222-1740; 70-90 years: interaction coefficient 1060, 95% CI 200-1920), White patients (interaction coefficient 995, 95% CI 360-1631), and patients with fewer comorbidities (interaction coefficient -517, 95% CI -1188 to -11) compared to women, those aged below 50, non-White patients, and patients with multimorbidity. In terms of interventional differences, only face-to-face delivery of the tracker impacted the effectiveness of the interventions by increasing steps per day. Conclusions In patients with cardiometabolic conditions, interventions using wearable trackers to improve steps per day mostly benefited older White men without multimorbidity. TRIAL REGISTRATION: PROSPERO CRD42019143012; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143012

Ambient greenness, access to local green spaces, and subsequent mental health: a 10-year longitudinal dynamic panel study of 2·3 million adults in Wales.

BackgroundLiving in greener areas, or close to green and blue spaces (GBS; eg, parks, lakes, or beaches), is associated with better mental health, but longitudinal evidence when GBS exposures precede outcomes is less available. We aimed to analyse the effect of living in or moving to areas with more green space or better access to GBS on subsequent adult mental health over time, while explicitly considering health inequalities.MethodsA cohort of the people in Wales, UK (≥16 years; n=2 341 591) was constructed from electronic health record data sources from Jan 1, 2008 to Oct 31, 2019, comprising 19 141 896 person-years of follow-up. Household ambient greenness (Enhanced Vegetation Index [EVI]), access to GBS (counts, distance to nearest), and common mental health disorders (CMD, based on a validated algorithm combining current diagnoses or symptoms of anxiety or depression [treated or untreated in the preceding 1-year period], or treatment of historical diagnoses from before the current cohort [up to 8 years previously, to 2000], where diagnosis preceded treatment) were record-linked. Cumulative exposure values were created for each adult, censoring for CMD, migration out of Wales, death, or end of cohort. Exposure and CMD associations were evaluated using multivariate logistic regression, stratified by area-level deprivation.FindingsAfter adjustment, exposure to greater ambient greenness over time (+0·1 increased EVI on a 0-1 scale) was associated with lower odds of subsequent CMD (adjusted odds ratio 0·80, 95% CI 0·80-0·81), where CMD was based on a combination of current diagnoses or symptoms (treated or untreated in the preceding 1-year period), or treatments. Ten percentile points more access to GBS was associated with lower odds of a later CMD (0·93, 0·93-0·93). Every additional 360 m to the nearest GBS was associated with higher odds of CMD (1·05, 1·04-1·05). We found that positive effects of GBS on mental health appeared to be greater in more deprived quintiles.InterpretationAmbient exposure is associated with the greatest reduced risk of CMD, particularly for those who live in deprived communities. These findings support authorities responsible for GBS, who are attempting to engage planners and policy makers, to ensure GBS meets residents' needs.FundingNational Institute for Health and Care Research Public Health Research programme

Green-blue space exposure changes and impact on individual-level well-being and mental health: a population-wide dynamic longitudinal panel study with linked survey data

Background: cross-sectional evidence suggests that living near green and blue spaces benefits mental health; longitudinal evidence is limited.Objectives: to quantify the impact of changes in green and blue spaces on common mental health disorders, well-being and health service use.Design: a retrospective, dynamic longitudinal panel study.Setting: Wales, UK.Participants: an e-cohort comprising 99,682,902 observations of 2,801,483 adults (≥ 16 years) registered with a general practice in Wales (2008-2019). A 5312-strong 'National Survey for Wales (NSW) subgroup' was surveyed on well-being and visits to green and blue spaces.Main outcome measures: common mental health disorders, general practice records; subjective well-being, Warwick-Edinburgh Mental Well-being Scale.Data sources: common mental health disorder and use of general practice services were extracted quarterly from the Welsh Longitudinal General Practice Dataset. Annual ambient greenness exposure, enhanced vegetation index and access to green and blue spaces (2018) from planning and satellite data. Data were linked within the Secure Anonymised Information Linkage Databank.Methods: multilevel regression models examined associations between exposure to green and blue spaces and common mental health disorders and use of general practice. For the National Survey for Wales subgroup, generalised linear models examined associations between exposure to green and blue spaces and subjective well-being and common mental health disorders.Results and conclusions: our longitudinal analyses found no evidence that changes in green and blue spaces through time impacted on common mental health disorders. However, time-aggregated exposure to green and blue spaces contrasting differences between people were associated with subsequent common mental health disorders. Similarly, our cross-sectional findings add to growing evidence that residential green and blue spaces and visits are associated with well-being benefits: • Greater ambient greenness (+ 1 enhanced vegetation index) was associated with lower likelihood of subsequently seeking care for a common mental health disorder [adjusted odds ratio (AOR) 0.80, 95% confidence interval, (CI) 0.80 to 0.81] and with well-being with a U-shaped relationship [Warwick-Edinburgh Mental Well-being Scale; enhanced vegetation index beta (adjusted) -10.15, 95% CI -17.13 to -3.17; EVI2 beta (quadratic term; adj.) 12.49, 95% CI 3.02 to 21.97]. • Those who used green and blue spaces for leisure reported better well-being, with diminishing extra benefit with increasing time (Warwick-Edinburgh Mental Well-being Scale: time outdoors (hours) beta 0.88, 95% CI 0.53 to 1.24, time outdoors2 beta -0.06, 95% CI -0.11 to -0.01) and had 4% lower odds of seeking help for common mental health disorders (AOR 0.96, 95% CI 0.93 to 0.99).• Those in urban areas benefited most from greater access to green and blue spaces (AOR 0.89, 95% CI 0.89 to 0.89).• Those in material deprivation benefited most from leisure time outdoors (until approximately four hours per week; Warwick-Edinburgh Mental Well-being Scale: time outdoors × in material deprivation: 1.41, 95% CI 0.39 to 2.43; time outdoors2 × in material deprivation -0.18, 95% CI -0.33 to -0.04) although well-being remained generally lower.Limitations: longitudinal analyses were restricted by high baseline levels and limited temporal variation in ambient greenness in Wales. Changes in access to green and blue spaces could not be captured annually due to technical issues with national-level planning datasets.Future work: further analyses could investigate mental health impacts in population subgroups potentially most sensitive to local changes in access to specific types of green and blue spaces. Deriving green and blue spaces changes from planning data is needed to overcome temporal uncertainties.Funding: this project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (Project number 16/07/07) and will be published in full in Public Health Research; Vol. 11, No. 10. Sarah Rodgers is part-funded by the NIHR Applied Research Collaboration North West Coast.</p

Research priorities to reduce the impact of COVID-19 in low- and middle-income countries

publishedVersio

Research priorities to reduce the impact of COVID-19 in low- and middle-income countries.

BackgroundThe COVID-19 pandemic has caused disruptions to the functioning of societies and their health systems. Prior to the pandemic, health systems in low- and middle-income countries (LMIC) were particularly stretched and vulnerable. The International Society of Global Health (ISoGH) sought to systematically identify priorities for health research that would have the potential to reduce the impact of the COVID-19 pandemic in LMICs.MethodsThe Child Health and Nutrition Research Initiative (CHNRI) method was used to identify COVID-19-related research priorities. All ISoGH members were invited to participate. Seventy-nine experts in clinical, translational, and population research contributed 192 research questions for consideration. Fifty-two experts then scored those questions based on five pre-defined criteria that were selected for this exercise: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity.ResultsAmong the top 10 research priorities, research questions related to vaccination were prominent: health care system access barriers to equitable uptake of COVID-19 vaccination (ranked 1st), determinants of vaccine hesitancy (4th), development and evaluation of effective interventions to decrease vaccine hesitancy (5th), and vaccination impacts on vulnerable population/s (6th). Health care delivery questions also ranked highly, including: effective strategies to manage COVID-19 globally and in LMICs (2nd) and integrating health care for COVID-19 with other essential health services in LMICs (3rd). Additionally, the assessment of COVID-19 patients' needs in rural areas of LMICs was ranked 7th, and studying the leading socioeconomic determinants and consequences of the COVID-19 pandemic in LMICs using multi-faceted approaches was ranked 8th. The remaining questions in the top 10 were: clarifying paediatric case-fatality rates (CFR) in LMICs and identifying effective strategies for community engagement against COVID-19 in different LMIC contexts.InterpretationHealth policy and systems research to inform COVID-19 vaccine uptake and equitable access to care are urgently needed, especially for rural, vulnerable, and/or marginalised populations. This research should occur in parallel with studies that will identify approaches to minimise vaccine hesitancy and effectively integrate care for COVID-19 with other essential health services in LMICs. ISoGH calls on the funders of health research in LMICs to consider the urgency and priority of this research during the COVID-19 pandemic and support studies that could make a positive difference for the populations of LMICs