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Identifying the Factors That Drive Health Service Utilization Among Healthy and Non-Healthy Agers in a Sample of Older Ethiopians:A Cross-Sectional Study
No full textBackground and Aims: Population aging is associated with the rising incidence of chronic illness. This presents a significant challenge to healthcare systems, particularly in developing countries, as untreated chronic conditions can lead to years of disability and loss of independence straining health budgets and resources. Promoting healthy aging can be one avenue for mitigating these challenges. This study aims to identify factors influencing health service use among healthy and non-healthy agers, utilizing the Andersen-Newman model that describes predisposing (including demographic characteristics, social structure, and health beliefs), enabling (related to the logistical aspects of obtaining care, such as personal and community resources), and need factors (referring to the individual's perceived and evaluated health status). Methods: Older adults (n = 545) in Bahir Dar, Ethiopia were surveyed about their health and health-seeking behaviors. Associations between risk factors and health service utilization were examined using Poisson regression with robust standard errors. Results: A total of 79.3% of older adults utilized health services, with consistent usage between healthy and non-healthy agers. Factors associated with increased health service utilization included severe (RR = 2.20; 95% CI: 1.56–3.09), and moderate (RR = 2.03; 95% CI: 1.44–2.85) disease severity, reporting comorbid conditions (RR = 1.14; 95% CI: 1.06–1.23), having health insurance (RR = 1.14; 95% CI: 1.05–1.23), not reporting loneliness (RR = 1.13; 95% CI: 1.02–1.26), and being financially independent (RR = 1.11; 95% CI: 1.00–1.22). Conversely, residing in rented housing (RR = 0.78; 95% CI: 0.62–0.98) and living greater than 30 min from a healthcare facility (RR = 0.62; 95% CI: 0.54–0.71) decreased health service utilization. Conclusion: Health service utilization was low compared to developed countries. This could be due to newer and improved health services in developed countries. Improving financial independence, health insurance coverage, access to healthcare facilities, and encouraging peer or family support can enhance healthcare access in Ethiopians.</p
Risk Factors of Standalone and Coexisting Forms of Undernutrition Among Children in Sub-Saharan Africa:A Study Using Data from 26 Country-Based Demographic and Health Surveys
No full textINTRODUCTION: Undernutrition in low- and middle-income countries (LMICs) remains a leading public health challenge. It accounts for one-third of the under-five mortality rate in sub-Saharan Africa (SSA). This study applied the composite index of anthropometric failure (CIAF) to assess the prevalence of various standalone and coexisting forms of undernutrition and identify associated risk factors.METHODS: Nationally representative demographic health survey (DHS) data from 26 SSA countries were used. A multilevel multinomial logistic regression analysis was conducted considering the hierarchical nature of DHS data and more than two categories of outcome variable. Four models were fitted and the model with the highest log-likelihood and lowest deviance was chosen as the best-fitted model. The adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval (CI) was presented as a measure of the effect.RESULTS: The overall prevalence of undernutrition among under-five children in SSA was 34.59% (95% CI: 34.35-34.82). Additionally, 20.49% (95% CI: 20.30-20.69) and 14.09% (95% CI: 13.92-14.26) of under-five children had standalone and coexisting undernutrition, respectively. The mother's educational level and household wealth status were the most significant shared drivers for standalone and coexisting undernutrition. On the other hand, child and health service factors were differentiating factors between standalone and coexisting undernutrition. Age of the child, sex of the child, type of birth, birth weight, adherence to age-appropriate feeding, antenatal care visit (ANC), place of delivery, and maternal educational status were the most significant determinants of various undernutrition forms in 0-23-month-old children. For 24-59-month-old children, age of the child, sex of the child, type of birth, household wealth status, and maternal education were identified as the main determinants of different forms of undernutrition.CONCLUSIONS: Our analysis revealed that distal factors were shared risk factors among standalone and coexisting forms of undernutrition. However, proximal and intermediate factors varied in the type and strength of the association between standalone and coexisting undernutrition. This implies that holistic and category-specific strategies are needed to significantly reduce undernutrition among under-five children in SSA.</p
“I forgot she used to make chocolate cake”:Digital storytelling supporting person-focussed dementia care: A qualitative thematic analysis
No full textReminiscence is a meaningful activity for people with dementia, but research implementing digital reminiscence tools into environments with older people is not well developed. This project sought to understand the effectiveness of a digital reminiscence tool in aiding person-centred dementia care with people attending a day respite centre and a group residential home, in metropolitan eastern Australia. This study used semi-structured interviews and ethnographic observations using a qualitative reflexive thematic analysis with seventeen participants including people with dementia (n = 8), their loved ones (n = 5) and staff n = 4) Themes identified were: 1. Remembering myself; 2. Reminiscing the person before and with dementia; 3. Enhanced relationships through self-expression; 4. Person-centred adaptation and the art of the interview; and 5. Future potential. Findings indicate that the StoryTiling app was user-friendly, supported reminiscence activities and enhanced person-centred care. The reminiscence activity enhanced relationships between participants, families, and carers, facilitating a deeper knowing of the person with dementia. The activities supported positive memories and emotions and helped reinforce the identity of the person with dementia in both their own mind, and their loved ones. The information captured in the StoryTiling process enabled person-centred care in improving the ability to know a person and being able to relate and respond to their individual needs, wants and goals. The process was dependent on the ‘art of the question’ and the ‘art of the interview’, particularly by people who know the person with dementia and are trauma-informed in order to effectively progress interviews and utilise them within the care environment. Enabling nudge activities that promote person-centred engagement such as reminiscence through digital storytelling may help foster person-centred care in the aged care sector.</p
Physical Health and Health Behaviours of Australians with Psychosis
No full textPeople living with psychosis live up to 20 years less compared to the general population. Cardiometabolic ill-health and barriers to health-related behaviour are significant contributors. This is a cross-sectional descriptive study of cardiometabolic health and health behaviours of consumers attending a public community mental health service in an Australian city. One hundred and fourteen consumers currently living with psychosis participated. Standard measures of cardiometabolic health, quality of life and, health-related behaviours were utilised. Data were analysed using descriptive statistics. The cohort reported higher fruit intake and physical activity, and lower excess alcohol use compared to previous studies. Health-related behaviours including smoking and vegetable intake were poorer than previously reported. Participants had low levels of cardiometabolic health (e.g. abnormal lipids). Physical and mental quality of life was also lower than for general populations. Improved efforts to address physical health for people with mental health conditions are urgently needed.</p
A Multiperspectival Approach to Democratic Theory:Five Lessons for Democratic Innovations
No full textDeliberative democratic theory and the practice of deliberative minipublics currently hold a dominant position within the study of democratic innovations. This one-dimensional view inhibits learning from other perspectives in democratic theory. Responding to the post-model debate in democratic theory, the article argues for a multiperspectival approach that combines the normative grounding provided by models with diversity and innovation. Through the multiperspectival approach, the article presents five lessons for democratic innovations. By engaging with conceptions of democratic space in participatory, deliberative, agonistic, feminist, and transformative democratic theory, it argues that democratic innovations need to be (1) grounded, (2) connected, (3) agonised, (4) embodied, and (5) politicised. Drawing on empirical studies, it translates these five lessons into concrete recommendations for designers of democratic innovations
Diving Into the Health Problems of Competitive Divers:A Systematic Review of Injuries and Illnesses in Pre-elite and Elite Diving Athletes
Get PDFContext: The Olympic sport of diving involves the competitive disciplines of 3 m springboard and 10 m platform. Although it is generally accepted that lumbar spine injuries are common in diving athletes, the existing literature of health problems in diving athletes remains scarce. Objective: To identify the incidence, prevalence, and type of health problems that occur in competitive diving athletes. Data Sources: Medline, EMBASE, SportsDiscus, PsycINFO, and Google Scholar. Study Selection: Studies written in English investigating elite or pre-elite competitive diving (springboard, platform) injuries and/or illnesses were eligible. Two independent reviewers screened for inclusion by title, abstract, and full text in accordance with the eligibility criteria. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Data extraction was completed by 1 author using a structured form. A second author then independently reviewed and verified the extracted data, any discrepancies were resolved through consensus. Results: The search identified 2554 potential articles, with 28 studies meeting eligibility criteria. The surveillance setting of most studies was restricted to competition-based events, with the reported injury incidence proportion ranging from 2.1% to 22.2%. The reported injury incidence rate ranged from 1.9 to 15.5 per 1000 athlete-exposures. Injuries to the shoulder, lower back/lumbar spine, trunk, and wrist/hand were reported most frequently. The prevalence of low back pain was reported as high as 89% (lifetime), 43.1% (period), and 37.3% (point). The illness incidence proportion ranged from 0.0% to 22.2%, with respiratory and gastrointestinal illness reported most frequently. Conclusion: Up to 1 in 5 diving athletes sustain an injury and/or illness during periods of competition. A reporting bias was observed, with most cohort studies limiting surveillance to short competition-based periods only. This limits the current understanding of the health problems experienced by diving athletes to competition periods only and requires expansion to whole-of-year surveillance.</p
Design, biomechanical modelling, and assist-as-needed control of a shoulder rehabilitation robot
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