Perceptions about family-centred care among adult patients with chronic diseases at a general outpatient clinic in Nigeria

Background: Few studies in Africa have described patients’ perceptions about family-centred care (FCC). Aim: The aim of this study was to explore perceptions of FCC among patients with chronic diseases. Setting: The study was conducted at a general outpatient clinic (GOPC) in Jos, north-central Nigeria. Methods: We used a mixed-methods phenomenological study design and conducted structured and semi-structured interviews with 21 adult patients with chronic diseases at a general outpatient clinic in north-central Nigeria. Results: Patients described FCC using progressive levels of family engagement including the doctor inquiring about history of similar disease in the family, information sharing with family members and fostering of family ties. They described current family involvement in their care as either inquiring about their health, accompanying them to the clinic or offering material or social support and health advice. Also, patients considered the value of FCC based on how it meets information needs of the family, influences individual health behaviour and addresses family dynamics. Those who were literate and older than 50 years of age favoured FCC during history taking. Those who were literate, aged lesser than 50 years and had poor disease control showed preference for FCC during treatment decision-making. Conclusion: The acceptability of FCC is a complex synthesis of age, socio-economic status, literacy and disease outcomes. Patients older than 50 years, with good treatment outcomes, and those without formal education may need further education and counselling on this approach to care

Successes, challenges and needs regarding rural health medical education in continental central America: A literature review and narrative synthesis

Introduction: Central American countries, like many others, face a shortage of rural health physicians. Most medical schools in this region are located in urban areas and focus on tertiary care training rather than on community health or primary care, which are better suited for rural practice. However, many countries require young physicians to do community service in rural communities to address healthcare provider shortages. This study aimed to: (a) synthesize what is known about the current state of medical education preparing physicians for rural practice in this region, and (b) identify common needs, challenges and opportunities for improving medical education in this area. Methods: A comprehensive literature review was conducted between December 2013 and May 2014. The stepwise, reproducible search process included English and Spanish language resources from both data-based web search engines (PubMed, Web of Science/Web of Knowledge, ERIC and Google Scholar) and the grey literature. Search criteria included MeSH terms: ‘medical education’, ‘rural health’, ‘primary care’, ‘community medicine’, ‘social service’, in conjunction with ‘Central America’, ‘Latin America’, ‘Mexico’, ‘Guatemala’, ‘Belize’, ‘El Salvador’, ‘Nicaragua’, ‘Honduras’, ‘Costa Rica’ and ‘Panama’. Articles were included in the review if they (1) were published after 1984; (2) focused on medical education for rural health, primary care, community health; and (3) involved the countries of interest. A narrative synthesis of the content of resources meeting inclusion criteria was done using qualitative research methods to identify common themes pertaining to the study goals. Results: The search revealed 20 resources that met inclusion criteria. Only four of the 20 were research articles; therefore, information about this subject was primarily derived from expert opinion. Thematic analysis revealed the historical existence of several innovative programs that directly address rural medicine training needs, suggesting that expertise is present in this region. However, numerous challenges limit sustainability or expansion of successful programs. Common challenges include: (a) physicians’ exposure to rural medicine primarily takes place during social service commitment time, rather than during formal medical training; (b) innovative educational programs are often not sustainable due to financial and leadership challenges; (c) the majority of physician manpower is in urban areas, resulting in few rural physician role models and teachers; and (d) there is insufficient collaboration to establish clinical and educational systems to meet rural health needs. Recurring suggestions for curricular changes include: (a) making primary care training a core component of medical school education; and (b) expanding medical school curricula in crosscultural communication and social determinants of disease. Suggestions for health system changes include: (a) improving living and working conditions for rural physicians; and (b) establishing partnerships between educational, governmental and non-governmental organizations and rural community leadership, to promote rural health training and systems. Conclusions: Expertise in rural medicine and training exists in continental Central America. However, there are numerous challenges to improving medical education to meet the needs of rural communities. Overcoming these challenges will require creative solutions, new partnerships, and evaluation and dissemination of successful educational programs. There is a great need for further research on this topic

Enhancing Resilience of Systems to Individual and Systemic Risk: Steps toward An Integrative Framework

Individual events can trigger systemic risks in many complex systems, from natural to man-made. Yet, analysts are still usually treating these two types of risks separately. We suggest that, rather, individual risks and systemic risks represent two ends of a continuum and therefore should not be analyzed in isolation, but in an integrative manner. Such a perspective can further be related to the notion of resilience and opens up options for developing an integrated framework for increasing the resilience of systems to both types of risks simultaneously. Systemic risks are sometimes called network risks to emphasize the importance of inter-linkages, while, in contrast, individual risks originate from individual events that directly affect an agent and happen independently from the rest of the system. The two different perspectives on risk have major implications for strategies aiming at increasing resilience, and we, therefore, discuss how such strategies differ between individual risks and systemic risks. In doing so, we suggest that for individual risks, a risk-layering approach can be applied, using probability distributions and their associated measures. Following the risk-layering approach, agents can identify their own tipping points, i.e., the points in their loss distributions at which their operation would fail, and on this basis determine the most appropriate measures for decreasing their risk of such failures. This approach can rely on several well-established market-based instruments, including insurance and portfolio diversification. To deal with systemic risks, these individual tipping points need to be managed in their totality, because system collapses are triggered by individual failures. An additional and complementary approach is to adjust the network structure of the system, which determines how individual failures can cascade and generate systemic risks. Instead of one-size-fits-all rules of thumb, we suggest that the management of systemic risks should be based on a careful examination of a system’s risk landscape. Especially a node-criticality approach, which aims to induce a network restructuring based on the differential contributions of nodes to systemic risk may be a promising way forward toward an integrated framework. Hence, we argue that tailor-made transformational approaches are needed, which take into account the specificities of a system’s network structure and thereby push it toward safer configurations for both individual risks and systemic risks

The Radical Complexity of Rewiring Supplier–Buyer Networks

This paper questions the dynamic stability of supplier-buyer networks. We investigate a simple rewiring process, by which firms change suppliers if it increases profit, within an otherwise classical production network model with market clearing, profit-maximization, and complete information. We find that these systems exhibit extremely vast sets of path-dependent and locally-stable configurations, in which firms have no interest to change suppliers. Following an external shock, the network undergoes a cascade of rewirings and reaches a new stable configuration. However the duration of those cascades quickly increases with network size, suggesting that, in real network made of millions of firm, locally-stable configurations are not likely to be ever reached. Moreover, as soon as firms have limited visibility over their supply chain, networks fail to stabilize and keep changing configurations forever. They either drift in the topological space or alternate within a reduced set of configurations. Our results are consistent with the well-known combinatorial problems marked by rugged dynamical landscapes. Because of such a radical complexity, one cannot assume that supplier-buyer networks are in equilibrium

Decision-Making as a Latent Construct and its Measurement Invariance in a Large Sample of Adolescent Cannabis Users

OBJECTIVE: Relative to the vast literature that employs measures of decision-making (DM), rigorous examination of their psychometric properties is sparse. This study aimed to determine whether three measures of DM assess the same construct, and to measure invariance of this construct across relevant covariates. METHOD: Participants were 372 adolescents at risk of escalation in cannabis use. DM was assessed via four indices from the Cups Task, Game of Dice Task (GDT), and Iowa Gambling Task (IGT). We used confirmatory factor analysis to assess unidimensionality of the DM construct, and moderated nonlinear factor analysis (MNLFA) to examine its measurement invariance. RESULTS: The unidimensional model of DM demonstrated good fit. MNLFA results revealed that sex influenced mean DM scores, such that boys had lower risk-taking behaviors. There was evidence of differential item functioning (DIF), such that IQ and age moderated the IGT intercept and GDT factor loading, respectively. Significant effects were retained in the final model, which produced participant-specific DM factor scores. These scores showed moderate stability over time. CONCLUSIONS: Indices from three DM tasks loaded significantly onto a single factor, suggesting that these DM tasks assess a single underlying construct. We suggest that this construct represents the ability to make optimal choices that maximize rewards in the presence of risk. Our final DM factor accounts for DIF caused by covariates, making it comparable across adolescents with different characteristics. (JINS, 2019, 25, 661-667)

Hand problems among endourologists.

BACKGROUND AND PURPOSE: Endourology has evolved rapidly for the management of both benign and malignant disease of the upper urinary tract. Limited data exist, however, on the occupational hazards posed by complex endourologic procedures. The aim of this study was to determine the prevalence and possible causes of hand problems among endourologists who routinely perform flexible ureteroscopy compared with controls. MATERIALS AND METHODS: An online computer survey targeted members of the Endourological Society and psychiatrists in academic and community settings. A total of 600 endourologists and 578 psychiatrists were contacted by e-mail. Invited physicians were queried regarding their practice settings and symptoms of hand pain, neuropathy, and/or discomfort. RESULTS: Survey responses were obtained from 122 (20.3%) endourologists and 74 (12.8%) psychiatrists. Of endourologists, 61% were in an academic setting and 70% devoted their practice to endourology. Endourologists were in practice for a mean 13 years, performing 4.5 ureteroscopic cases per week with a mean operative time of 50 minutes. Hand/wrist problems were reported by 39 (32%) endourologists compared with 14 (19%) psychiatrists (P=0.0486, relative risk [RR]=1.69). Surgeons who preferred counterintuitive ureteroscope deflection were significantly more likely to have problems (56%) compared with intuitive users (27%) (RR 2.07, P=0.0139) or those with no preference (26%) (RR 2.15, P=0.0451). Overall, most respondents (85%) with hand/wrist problems needed either medical or surgical intervention. CONCLUSIONS: Hand and wrist problems are very common among endourologists. Future studies are needed to develop more ergonomic platforms and thereby reduce the endourologist\u27s exposure to these occupational hazards