We explored the ‘coping reflections’ of elderly couples living alone (without any other family members) during the COVID-19 pandemic in urban Odisha, India.

Evidence worldwide suggests that older people are at increased risk from COVID-19 adverse outcomes and experience greater stress. In our previous community-based study urban dwelling, particularly elderly participants, and living alone reported higher pandemic-associated health care challenges than their rural and residing-with-family counterparts. We intended to explore how the elderly couples living alone coped through this challenging yet stressful situation during the COVID-19 pandemic and what were their key strategies adopted toward this.

We conducted telephonic in-depth interviews (IDIs) with 11 urban elderly couples living alone in Bhubaneswar city of Odisha, India using a semi-structured interview guide. All IDIs were digitally recorded, transcribed into the original language, and translated to English. We used a thematic approach for analysis.

Four themes emerged: (1) Risk appraisal and feeling vulnerable; (2) Safeguarding against COVID-19; (3) Managing routine health care and emergency; and (4) Pursuing mental and psychological well-being. Although fear, anxiety, and loneliness were continuing stressors, many of them learnt to adapt and emerge resilient with the evolving situation. Various elements at the individual, family, community, and organizational levels were conducive to better coping. The companionship and complementary support of spouse, self-health literacy, and digital efficacy, virtual connectedness with family and friends, availability of community pharmacy and diagnostic services in the vicinity, support of neighbors, reengaging with creative leisure time activity, and assurance of a responsive administration at the time of emergency helped them to cruise through the pandemic. Furthermore, watching the re-telecast of prime time serials made these elderly fondly remember their own youth time memories. Self-health monitoring, indoor physical exercise, spiritual practices, continuation of previous prescription, telephonic advice of physicians were add-on strategies that facilitated their physical and psychological well-being during the pandemic.

To examine and describe the current evidence about occupational therapy services in primary care.

Interprofessional primary care teams have been introduced to support the changing demographics and provide more comprehensive and coordinated care. Occupational therapists have the opportunity to play an important role in this expanding area of practice. To do so, occupational therapists must develop roles built on evidence and a clear understanding of the care delivery context.

A scoping review was conducted based on the scientific and grey literature. Studies that described or examined the occupational therapy role with clients (individuals, groups, communities, populations) of all ages, conditions or occupational issues in a primary care context and that presented or referred to an occupational therapist working in a primary care setting were included. Studies were excluded if they were not in English or French. The Canadian Model of Occupational Performance and Engagement was used to chart the data.

129 articles were identified, with 62 non-research and 67 research-focussed articles. A total of 268 assessments and 868 interventions were identified. The top interventions offered by occupational therapists were referring to/advocating for/coordinating/linking to and navigating community services (n = 36 articles), chronic disease management (n = 34 articles)/self-management education (n = 28 articles), health promotion (n = 30 articles) and falls prevention (n = 27 articles). The predominant focus in the literature is on adult and older adult populations.

Currently, there is limited knowledge on the impact of father-only sessions or parenting programs supporting impending fatherhood. This research explored an antenatal dads program aimed at fathers to assess the benefits of such interventions.

Literature regarding parenting programs and early childhood education initiatives, especially those aimed at children and families in disadvantaged circumstance, have been demonstrated to act as a buffer to poorer health and lifestyle outcomes in later life.

A qualitative research approach was used to explore the experiences of 16 fathers and 6 staff of a community-based parenting program with sessions focusing on fatherhood.

Four main themes were identified from the data regarding the experiences of groups engaged with the Antenatal Dads and First Year Families program. The first theme ‘Knowledge and Capacity Building’ stated that the information provided in the program helped fathers to be better informed and prepared for their impending fatherhood. The second theme was ‘Mental Health Awareness’ and identified the importance of raising awareness of depression and suicide in fathers, including where and how to get help. The third theme was ‘Soft-Entry’ and highlighted how the attendance at one service helped participants to learn about additional services through word of mouth and targeted promotion. The final theme was ‘Feeling Connected’, which helped fathers to feel more connected with the process of childbirth and development including playing and engaging with their children. Overall, the fathers found that the male-only sessions assisted them by supporting frank discussions on fatherhood. Additionally, the study helped identify the advantages of fathers meeting other fathers through attendance in the program, or even other couples in similar situations that helped fathers to feel less lonely regarding their situation.

To evaluate a new service development whereby a nurse and a paramedic working in partnership attended non-urgent emergency calls.

The demand for emergency ambulance services both nationally (in the UK) and internationally has been steadily increasing. A large proportion of calls made to the emergency ambulance service are classified as non-urgent. An alternative response to these calls may release the standard ambulance service to attend more urgent calls. A pilot project was initiated in order to provide an alternative response to non-urgent emergency calls in an Ambulance Trust in England with support from the local Primary Care Trust. This alternative response comprised a district nurse or an emergency nurse practitioner dispatched with a paramedic to visit low-priority emergency calls. The pilot service was trialled during a 15-week period in 2003–2004.

This paper evaluates the cost effectiveness of the pilot service by examining both the resource use and the outcomes of the service.

It was found that introducing this service to the current provision would increase the overall cost to the ambulance services. However, a reduction in conveyance rate to the hospital was observed as people could be treated on-scene. A reduction in conveyance rate to the hospital would lead to reduced admissions to accident and emergency departments and subsequent hospitalization. This paper provides an indication that further development of this type of service has the potential to be cost effective, if the wider health care economy is considered, as the cost savings made in secondary care could more than balance the costs to the Ambulance Services in providing such a service.

Mental ill-health and pain are major causes for disability compensation in female adults in Sweden.

The aims of this study were to (1) analyse gender differences in the prevalence of depression among immigrant patients with chronic back pain and (2) explore whether factors such as age, marital status, educational level, religious faith, number of children and number of diagnosed pain sites could explain these differences.

The study sample consisted of 245 sick-listed primary care patients in consecutive order aged 18 through 45 years with a median duration of sick leave of 10 months for back pain and participating in a rehabilitation programme. Explanatory variables included physicians’ diagnosed pain sites, age, marital status, education, number of children and religious affiliation. Predictive factors for depression were analysed using logistic regression.

The women differed significantly from the men in three aspects: they were less educated, had more children and had more multiple pain sites, that is, 68% versus 45%. In the age-adjusted model, women were twice as likely to have depression (odds ratio (OR) 2.1). Regardless the gender, those with intermediate education of 9–11 years had the lowest odds of outcome compared with those with <0–8 years and ⩾12 years education. Finally, after adjusting for all explanatory variables, the ORs of depression for women decreased to a non-significant level (OR 1.8; 95% confidence interval (CI) 0.94–3.43). Furthermore, regardless of the gender, those with multiple pain sites had twice higher odds (OR 2.04; 95% CI 1.11–3.74) of depression than those with fewer pain sites.

Gender differences in odds of depression in our study could be explained by a higher prevalence of diagnosed multiple pain sites in women. This calls for tailor-made treatments that focus on the pain relief needs of immigrant women with low education and chronic back pain.

To examine general practitioners’ knowledge of and their role in tackling health inequalities, in relation to their professional responsibilities.

Primary care is often seen as being in the frontline of addressing health inequalities and the social determinants of health (SDH).

A qualitative study with a maximum variety sample of English General Practitioners (GPs). In-depth, semi-structured interviews were held with 13 GPs in various geographical settings; they lasted between 30 and 70 min. Interviews were audio-recorded and transcribed. The analysis involved a constant comparison process undertaken by both authors to reveal key themes.

GPs’ understanding of health inequalities reflected numerous perspectives on the SDH and they employ various different strategies in tackling them. This study revealed that GPs’ strategies were changing the nature of (medical) professionalism in primary care. We locate these findings in relation to Gruen’s model of professional responsibility (comprising a distinction between obligation and aspiration, and between patient advocacy, community participation and political involvement). We conclude that these GPs do not exploit the full potential of their contribution to tackling health inequalities. These findings have implication for policy and practice in other practitioners and in other health systems, as they seek to tackle health inequalities.

Current clinical practice guidelines have suggested that each individual with knee osteoarthritis (OA) should receive three core treatments from their health care provider. These core treatments comprise of exercise, education and weight loss. Identification of the health care and rehabilitation needs of individuals with knee OA in rural areas are imperative for focusing service delivery in a specific context in order to empower the individual. The aim of this study was to explore the rehabilitation needs of individuals with knee OA living in rural Western Cape in order to identify the gaps in services offered and inform rehabilitation programmes in these settings.

Semi-structured in-depth individual interviews were performed on 16 individuals with knee OA living in rural settings of the Western Cape, South Africa. A deductive data analysis approach was used and the needs of the individuals were identified and categorised for interpretation and comparison with the reported services received.

The three major themes identified were ‘I would like to know more’, ‘There’s not much support from the clinic’ and ‘I don’t feel myself anymore’. These themes relate to the lack of disease-specific education, barriers in the health systems and service delivery resulting in individuals lack of self-worth and poor mental wellbeing. The results revealed the integral relationship between health care systems, service delivery and the effect on patient wellbeing.

The rehabilitation needs of individuals with knee OA in rural areas advocates for addressing barriers in rural primary health care system such as adequate human resources, referral systems and continuity of care. This will allow for a comprehensive, person-centred and context-specific multidisciplinary approach focused on empowering individuals with knee OA through disease-specific education, improving functional participation and symptom management strategies. This could improve the social inclusion and mental wellbeing of individuals living with knee OA.

This study aimed to identify nurses’ views on influenza vaccination and factors that might explain why they do not receive influenza vaccinations, and to examine any ethical issues encountered in the vaccination process.

All 27 European Union member states and 2 other European countries recommended influenza vaccinations for healthcare workers in 2014–15. Data show that the influenza vaccination rate among nurses in Slovenia is even lower than in other European countries. Slovenian study showed that 41.7% of the respondents had received both the pandemic and the seasonal vaccine. Doctors had the highest level of vaccine coverage, with 44.1%, followed by registered nurses at 23.4%, whereas the lowest level was found among nursing assistants and nursing technicians (17%) at a Ljubljana health clinic.

A qualitative study was carried out. Nineteen nurses who did not receive influenza vaccination took part in the study. Thematic interviews were conducted in December 2018. Interview transcripts were read, coded, reviewed and labelled by three independent researchers. The collected material was processed using qualitative content analysis.

Thirteen categories and four themes were identified and coded, which enabled an understanding of the nurses’ views regarding influenza vaccination. Most of their experiences were positive in one way: they recognised the importance of vaccination and people’s awareness of it. However, they did not obtain the influenza vaccine themselves. The main barriers to vaccination were doubt regarding the vaccine’s effectiveness, the potential for side effects, the belief that young healthcare professionals are well protected and not at high risk, an overrated trust in their own immune systems, and the belief that pharmaceutical industry marketing was targeting them. The nurses suggested several ways that vaccination could be promoted and improved vaccination coverage achieved. These findings call attention to the importance of recognising both the need for targeted information for the nurses and the need for different approaches to healthcare provision.

To determine whether an educational strategy using a handheld, multimedia computer (iPod™) is practical and sustainable for routine office-based patient educational tasks.

With the limited amount of time allotted to the office encounter and the growing number of patient educational tasks, new strategies are needed to improve the efficiency of patient education. Education of patients anticoagulated with warfarin is considered critical to preventing complications. Despite the dangers associated with the use of warfarin, educational practices are variable and often haphazard

During a four-month period, we examined the implementation of a three-part series of iPod™-based patient educational modules delivered to anticoagulated patients at the time of routine INR (International Normalized Ratio) blood tests for outpatients on the anticoagulation registry at an urban community health center.

A total of 141 computer module presentations were delivered to 91 patients during the four-month period. In all, 44 patients on the registry had no INR checkups, and thus no opportunity to view the modules, and 32 patients had at least three INR checkups but no modules were documented. Of the 130 patients with at least one INR performed during the study period, 22 (16.9%) patients completed all three modules, 91 (70.0%) patients received at least one module, and nine (7.6%) patients refused to view at least one module. Neither of the two handheld computers was lost or stolen, and no physician time was used in this routine educational activity. Patients reported that the audio and visual quality was very good, (9.0/10); the educational experience of the patient was helpful (7.4/10) compared with the patient's previous warfarin education (6.3/10), and the computer strategy extended the INR visit duration by 1–5 min at most.

The computer-assisted patient educational strategy was well received by patients, and uptake of the intervention by the clinic was successful and durable. The iPod™strategy standardized the educational message, improved clinic efficiency, and helped this busy clinic meet its educational goals for patient education.

The depth and breadth of problems related to depressive symptomatology and optimal treatment outcomes, including medication treatment adherence, have long been documented in the literature. Missing are clear explanations as to what factors and patient characteristics may account for lack of medication treatment adherence.

The two objectives of the current study were to examine the predictive strength of depression, patient characteristics, and patient attachment style regarding medication treatment adherence and to consider the extent to which attachment styles mediate the relation between depression and medication treatment adherence.

Participants in the present study were 237 racially diverse American primary care patients with a diagnosis of hypertension who were participants in a clinical trial. Depression, patient characteristics, attachment style, and medication treatment adherence were assessed.

Partly consistent with our four hypotheses, the following results were found: (a) Black American, younger, never married, and poorer patients had lower medication treatment adherence (b) depression was significantly associated with lower self-reported medication adherence; (c) insecure–dismissing attachment style was related to lower medication adherence; and (d) insecure–dismissing attachment style mediates the relation between depression and medication treatment adherence by exacerbating the negative association.

Physicians and other primary care providers should consider how depressive symptomatology, patient characteristics, and attachment style may inform the treatment plans they put forward and the extent to which patients may adhere to those treatment plans.

Type 2 diabetes (T2D) has tremendous morbidity burden owing to disease management and complication prevention. Behavior modification identified as a key to management includes healthy diet and regular physical activity (PA). This study aims to identify patterns and preferences of PA of T2D patients and explore perceived enablers and barriers for diabetes control in Bhubaneswar.

Cross-sectional, facility-based study conducted in the private sector from June to August 2014 recruited 321 T2D patients using semi-structured questionnaires. Descriptive statistics and associations of PA were computed.

Almost two-thirds of patients (59%) were reported performing PA frequently. Majority patients cited walking as the most preferred mode of PA (79%) with 41% performing PA daily. Actual versus perceived weight was a complete mismatch with most patients misjudging their weight. Reasons for enabling PA included ‘controlling diabetes’ and ‘doctor’s advice’ as key factors, while ‘lack of time’ and ‘unwillingness’ were main barriers among inactive patients.

Counseling on PA by physicians during routine visits, along with tailored or patient-specific interventions should be considered. Focus on social support for positive behavioral changes and motivation play a central role in diabetes control.