Conectar
To explore health professionals’ perspectives on the barriers and enablers of healthcare access for older adults in Cambodia.
A qualitative study based on semi-structured interviews conducted in Khmer, recorded, transcribed, translated into English and analysed using an abductive thematic analysis approach.
Phnom Penh, Cambodia.
A purposive sample of 11 health professionals serving in diverse roles and sectors participated in the study.
Three key barriers emerged: (1) institutional barriers, (2) patient-specific access barriers and (3) communication barriers. However, four key enablers were also identified: (1) supportive healthcare environment, (2) reaching out to improve access to health services, (3) peer and community engagement and (4) government direct support to access healthcare. Despite previous policy efforts, gaps in the implementation of healthcare services for older adults persist across all health facilities. Health professionals identified that improving healthcare access for older adults in Cambodia requires a multifaceted strategy involving proactive outreach, health promotion, financial assistance and stronger community and family support.
Effective policy implementation requires collaboration among stakeholders and the active involvement of older adults in programme design to enhance dignity and well-being in Cambodia’s ageing population.
The aim of this study was to analyse associations between crowded housing and children’s indoor living environment, respiratory and allergic disorders and general health.
A cross-sectional study.
Sweden, using data from the Swedish National Environmental Health Survey 2019.
The study sample included 48 512 children (aged 6–10 months, 4 years and 12 years). We also investigated associations in vulnerable subgroups, such as children with asthma and those living under unfavourable socioeconomic conditions.
Primary outcomes in the living environment were at least one sign of mould, poor indoor air quality, unpleasant odours, too warm indoors in summer and too cold indoors in winter. Primary outcomes for children’s health were asthma, airway problems, breathing difficulties, rhinitis symptoms, mould and mites allergy, pollen allergy, furred pet allergy and good general health.
About one in five children lived in an overcrowded home. Factors from the indoor living environment such as perceived poor indoor air quality and mould were significantly associated with crowded housing. Moreover, children who lived in overcrowded conditions were less likely to report good general health than children in non-crowded households (OR 0.64, 95% CI 0.54 to 0.76). This association was even stronger in children with asthma (OR 0.51, 95% CI 0.34 to 0.77). Few significant associations were, however, observed with the respiratory and allergic health outcomes.
Crowded housing is associated both with a poor indoor environment and with poorer general health in children. Children with asthma may experience even poorer general health.
Research indicates various barriers to cervical cancer screening for transgender people, contributing to cancer inequities. Further research is required to better understand how these barriers affect experiences along the screening trajectory, from engaging with information, through invitation and testing, to receiving test results. Research exploring how transgender people navigate these barriers is also required.
To explore the experiences of cervical cancer screening in Sweden among transgender people who were assigned female at birth, and to identify touchpoints in need of improvement along the cervical cancer screening trajectory.
Qualitative interview study inspired by journey mapping.
Semi-structured interviews (n = 18) and interpretive description analysis.
Five phases were identified comprising participants' cervical cancer screening journey, with touchpoints in each phase indicating key experiences, barriers, and strategies to navigate barriers. Experiences of touchpoints were affected by four interrelated dimensions: The embodied person—personal gender identity, relationship with own body, and transition process; System factors—policies, routines, and practices; Gender norms and transphobia; and Prior healthcare experiences. Significant barriers included a lack of trans-specific screening information; an invitation system that does not automatically invite male-registered individuals with a cervix; lack of trans competency among clinics and staff; female-centred clinics; gender dysphoria; anticipation or fear of being mistreated; distrust of healthcare authorities; and participant-staff power dynamics.
To make cervical cancer screening more equitable for transgender people, barriers need to be addressed by considering the four dimensions that affect these barriers.
Findings show that staff involved in policy and clinical practice can improve transgender people's experiences of cervical cancer screening by promoting agency and self-determination in each screening phase. This involves providing inclusive information, continuing invitations for male-registered individuals with a cervix, enhancing trans-competency, and addressing power dynamics in staff-participant interactions.
The Standards of Reporting Qualitative Research (SRQR).
Representatives from the Regional Cancer Centre Stockholm–Gotland were involved in the conceptualisation of this study. Representatives from trans and LGBTQI+ organisations, Regional Cancer Centres, and the National Board of Health and Welfare have provided feedback during the analysis and writing phases.
To explore how frail older patients experience their stay and nursing care during boarding time at the emergency department.
A qualitative explorative interview study.
Purposive sampling was used, with a two-step selection process: (1) Patients 65 years or older spending at least 4 h at the emergency department waiting for a hospital bed, referred to as boarding time, were (2) screened for frailty using the FRail Elderly Support researcH group screening instrument. If screening identified a patient as frail, they were eligible for an interview. Individual semi-structured interviews (n = 19) were conducted during patients' boarding time at the emergency department. Data was collected between March and April 2019. The theoretical Fundamentals of Care framework shaped the interview guide. Interviews were transcribed and an inductive latent content analysis was performed.
The findings resulted in four main categories: Frail older patients felt disregarded, defenceless, and resigned during boarding time at the emergency department, yet also hopeful. The experience of hope resulted from confidence in the nurses, good nursing care, patience towards one's situation, and hope in emergency care.
The frail older patient experienced boarding time in the emergency department through an overarching theme: ‘being left in no-man's land in the emergency department but still feeling hopeful’. A trusting nurse–patient relationship, integrating the provision of fundamental care, is a favourable factor for the well-being of the frail older patient.
The study addressed the increased number of older adults with complex health needs, coupled with overcrowded emergency departments. Frail older patients perceive the boarding time as being left in a ‘no-man's-land’, addressing unclear information and lack of caregiver responsibility. This highlights the need for tailored guidelines and care practices that promote person-centred care and ensure safety for this vulnerable group in emergency settings.
Not applicable.
The use of direct oral anticoagulants (DOACs) as stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF) has increased steadily since the introduction in 2011. In Sweden today, more patients are treated with DOACs than with warfarin. However, it is not shown that an increased proportion of DOAC prescriptions correlates to lower event rates of stroke and systemic embolism.
This study aims to investigate whether the increased prescription of DOACs in Sweden correlates with lower event rates for all-cause stroke, systemic embolism and bleeding complications, using real-life data for the whole NVAF population.
Nationwide retrospective register study.
Data were obtained from the Swedish National Patient Registry, covering patients aged 18 years or older with NVAF, between 1 January 2014, and 31 December 2017. Exposure to oral anticoagulants was determined based on pharmaceutical data, calculating treatment duration by the number of pills dispensed and the prescribed daily usage rate. Baseline characteristics and endpoints were collected from hospital administrative registers using International Classification of Diseases, 10th edition (ICD-10) codes.
All patients with NVAF were identified using ICD-10 codes during the study period. Entry criteria included having a first recorded atrial fibrillation diagnosis after 1 January 2014 or being previously diagnosed with atrial fibrillation before 2014 but still receiving care after this date.
The outcomes were event rates (per 100 person-years) of ischaemic stroke, systemic embolism, all-cause stroke, major bleeding and intracranial bleeding (including haemorrhagic stroke). Event rates were calculated and compared across the study period using Cox proportional hazard models.
In the total NVAF population, the proportional decrease in event rates (per 100 treatment years) in 2017 compared with 2014 was ischaemic stroke 24% (1.70–1.30), all-cause mortality 4% (9.40–9.00), all-cause stroke 24% (2.10–1.60) and all-cause stroke and systemic embolism 23% (2.20–1.70). During the same time, the proportion of major bleeding and intracranial bleeding rates, including haemorrhagic stroke, also decreased: 5% (2.00–1.90), 6% (0.68–0.64) and 17% (0.30–0.25), respectively. DOACs use increased from 4.1% to 28.3% in the total population and from 22.7% to 60.9% in newly diagnosed patients.
In the initial years following the introduction when DOAC uptake in the population was high, an increasing proportion of Swedish NVAF patients receiving DOACs was accompanied by lower event rates of all-cause stroke and systemic embolism, ischaemic stroke and all-cause mortality, intracranial bleeding and major bleeding, highlighting the improved risk-benefit balance of DOACs in stroke prophylaxis.
There is a need for diagnostic and prognostic biosignatures to improve long-term outcomes in inflammatory bowel disease (IBD). Here, we describe the establishment of the Swedish Inception Cohort in IBD (SIC-IBD) and demonstrate its potential for the identification of such signatures.
Patients aged ≥18 years with gastrointestinal symptoms who were referred to the gastroenterology unit due to suspected IBD at eight Swedish hospitals between November 2011 and March 2021 were eligible for inclusion.
In total, 367 patients with IBD (Crohn’s disease, n=142; ulcerative colitis, n=201; IBD-unclassified, n=24) and 168 symptomatic controls were included. In addition, 59 healthy controls without gastrointestinal symptoms were recruited as a second control group. Biospecimens and clinical data were collected at inclusion and in patients with IBD also during follow-up to 10 years. Levels of faecal calprotectin and high-sensitivity C-reactive protein were higher in patients with IBD compared with symptomatic controls and healthy controls. Preliminary results highlight the potential of serum protein signatures and autoantibodies, as well as results from faecal markers, to differentiate between IBD and symptomatic controls in the cohort. During the first year of follow-up, 37% (53/142) of the patients with Crohn’s disease, 24% (48/201) with ulcerative colitis and 4% (1/24) with IBD-U experienced an aggressive disease course.
We have established an inception cohort enabling ongoing initiatives to collect and generate clinical data and multi-omics datasets. The cohort will allow analyses for translation into candidate biosignatures to support clinical decision-making in IBD. Additionally, the data will provide insights into mechanisms of disease pathogenesis.
Despite a variety of literature reviews, there is limited understanding of the learning strategies healthcare professionals use to help patients adopt and maintain effective foot care practices.
To explore learning processes and educational strategies for persons with diabetes focusing on foot care and examine how different learning processes influence these strategies.
The scoping review followed the methodological framework established by Arksey and O'Malley and refined by Levac et al. Additionally, the PRISMA-ScR checklist was followed. A literature search was conducted in the PubMed, CINAHL, MEDLINE and Academic Search Premier databases, using specific search terms related to diabetic foot care and learning strategies. The selection process involved screening 906 articles based on inclusion criteria such as relevance to diabetic foot care, learning processes, and educational strategies, and excluded studies that were not written in English. The data were charted and quantitative and qualitative data were synthesised and thematically analysed to identify key learning strategies.
The analysis identified two main themes: learning insights for comprehensive understanding and self-efficacy, and increased practical knowledge leads to improved footcare. Subthemes included integrative and reflective learning, motivational and collaborative learning, task-oriented and procedural learning, and feedback and reinforcement-based learning.
Effective diabetic foot care education should be multifaceted, incorporating deep learning, practical skills, and motivational elements. Early learning plays a central role in this process. Tailoring educational interventions to personal learning styles and providing continuous support can significantly improve patients' foot care outcomes. A framework for understanding the progressive stages of patient learning and self-management is presented as a starting point. Future research should focus on developing and evaluating educational models that address diverse learning needs, ultimately contributing to better management and prevention of diabetic foot complications.
It has been suggested that nursing shift-to-shift handover should be a more team-based dialogue with and for the patient rather than about a patient.
The aim of this study was to evaluate patient participation in relation to the implementation of the person-centered handover (PCH).
A pretest–posttest design was used without a comparison group, including patients from nine units in a university hospital at pretest (n = 228) and after implementing PCH (posttest, n = 253) per the framework integrated-Promoting Action on Research Implementation in Health Services. The PCH is inspired by an Australian bedside handover model. The Patient Preferences for the Patient Participation tool was used to rate the preference for and experience of participation on 12 items, combined into three levels of preference-based participation (insufficient–fair–sufficient).
There were no differences regarding experience or preference-based participation between patients at pretest–posttest; however, posttest patients experienced participation in the item Reciprocal communication to a lesser extent than the pretest patients. Only 49% of the posttest group received PCH; of those not receiving PCH, some would have wanted PCH (27%), while some would have declined (24%). Patients receiving PCH had sufficient participation (82%), to a greater extent, regarding the item Sharing one's symptoms with staff than patients at pretest (72%). Patients receiving PCH also had sufficient participation, to a greater extent, than patients at posttest who did not receive, but would have wanted PCH, regarding four items: (1) sharing one's symptoms with staff, (2) reciprocal communication, (3) being told what was done, and (4) taking part in planning.
Most patients want to be present at PCH. Therefore, nurses should ask for the patients' preferences regarding PCH and act accordingly. Not inviting patients who want PCH could contribute to insufficient patient participation. Further studies are needed to capture what assistance nurses would want in identifying and acting in alignment with patient preferences.
FreshRSS 