scholarly journals Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data

2021 ◽  
Vol 10 (8) ◽  
pp. 1782
Author(s):  
Ignacio Ricci-Cabello ◽  
Aina María Yañez-Juan ◽  
Maria A. Fiol-deRoque ◽  
Alfonso Leiva ◽  
Joan Llobera Canaves ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Structural Equation ◽  
Structural Equation Models ◽  
Cross Sectional ◽  
Morbidity Burden ◽  
Patient Reported ◽  
Patient Complexity ◽  
Complex Relationships ◽  
The Impact

We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men.

scholarly journals Impact of acculturation and psychological adjustment on mental health among migrant adolescents in Guangzhou, China: a cross-sectional questionnaire study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e022712 ◽  
Author(s):  
Lishuo Shi ◽  
Wen Chen ◽  
Jennifer Huang Bouey ◽  
Yanwei Lin ◽  
Li Ling
Keyword(s):  
Mental Health ◽  
Social Interaction ◽  
Psychological Adjustment ◽  
Structural Equation ◽  
Structural Equation Models ◽  
Questionnaire Study ◽  
Cross Sectional ◽  
Internal Migrant ◽  
Migrant Adolescents ◽  
The Impact

ObjectivesThe aim of this study was to examine the pathway and associations among acculturation (ie, language, social interaction and lifestyle), psychological adjustment and mental health of internal migrant adolescents in China.DesignCross-sectional questionnaire study.SettingSix private migrant junior high schools located in Tianhe and Baiyun districts in Guangzhou were chosen as the study sites.ParticipantsA total of 1122 migrant adolescents aged 11–17 years old completed the study.Main outcome measuresMental health was measured by using the Social Anxiety Scale for Children (SASC) and major depression disorder (MDD) in a Brief Child and Family Phone Interview. Acculturation and psychological adjustment were measured by a self-designed and verified questionnaire. Multiple regression models and structural equation models were performed to analyse the association among acculturation, psychological adjustment and mental health while controlling for participant demographic characteristics.ResultsThe average MDD score for boys was 8.78 (SD=2.17) and for girls was 8.56 (SD=2.22), while the average SASC score for boys was 14.67 (SD=3.72) and for girls was 13.41 (SD=4.01). Psychological adjustment had a direct positive effect on MDD (p<0.001, β=0.30) and SASC (p<0.001, β=0.28), and it was the key variable fully mediating the impact of acculturation components on MDD and partly mediating the impact of acculturation on SASC, whereas lifestyle showed a direct negative effect (p=0.003, β=−0.17) on SASC. Of the three acculturation components, lifestyle had the strongest influence on psychological adjustment (p<0.001, β=0.37 and 0.51), followed by social interaction (p<0.001, β=0.24 and 0.13) and language (p<0.001, β=0.17 and 0.11).ConclusionsThe association between acculturation and the mental health of internal migrant adolescents was complex and could be mediated by psychological adjustment. Interventions such as promoting local language and social interaction are needed to enhance psychological adjustment and further improve the mental health of migrant adolescents.

scholarly journals Mediating effects of nurses ‘personal and organizational values between organizational commitment and turnover: Cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258387
Author(s):  
Wentong Wei ◽  
Mengxin Gan ◽  
Yanhui Liu ◽  
Mengyu Yang ◽  
Jingying Liu
Keyword(s):  
Organizational Commitment ◽  
Turnover Intention ◽  
Structural Equation ◽  
Structural Equation Models ◽  
Multivariate Regression Analysis ◽  
Organizational Values ◽  
Mediating Effect ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Impact

Background The values of individuals and organizations are the core factors driving and guiding nurses’ decision-making and actions. Previous studies mainly focused on the impact of organizational commitment and other influencing factors on turnover intention. Aim To explore the mediating effect of personal and organizational values matching the relationship between organizational commitment and turnover intention of nursing staff. Methods A cross-sectional survey of 490 subjects in four tertiary hospitals in Tianjin was conducted by convenient sampling. Multivariate regression analysis and structural equation models were used to test each hypothesis. Results The results showed that there is a negative correlation between personal and organizational values, organizational commitment and turnover intention, and personal and organizational values played an indirect intermediary role between organizational commitment and turnover intention. Conclusions Organizational commitment reduces nurses’ turnover intention indirect through personal and organizational values paths. Leaders can improve nurses’ values as members of the organization, so as to participate in their own work more actively. Implications for nursing management Managers should effectively reduce the turnover rate and stabilize the nursing team by improving the organizational commitment and personal and organizational values of clinical nurses.

The Impact of Family Resources and Satisfaction with Division of Labour on Coping and Worries after the Birth of the First Child

1999 ◽  
Vol 23 (2) ◽  
pp. 431-456 ◽  
Author(s):  
Werner Wicki
Keyword(s):  
Family Environment ◽  
Structural Equation ◽  
Structural Equation Models ◽  
Division Of Labour ◽  
Parental Coping ◽  
Family Resources ◽  
Cross Sectional ◽  
Longitudinal Effects ◽  
One Year ◽  
The Impact

Data on spouse support, family environment (cohesion and conflict), worries and depressed mood, parental coping, ”nancial resources, and employment status were recorded longitudinally by means of questionnaires among Swiss first-time parents. The first data collection was administered when the first-born child was aged between two and six months, the second one year later. Both mothers ( n = 164) and fathers ( n = 164) completed separate questionnaires. Structural equation models suggested both cross-sectional and longitudinal effects of cohesion, conflicts, and partner support on parental coping and worries/mood. Additional LISREL analyses revealed that both mothers’ perceptions of family resources and their worries/mood were affected by the couples’ satisfaction with division of labour (SWDL), and that the latter was related to the perception of ”nancial resources. Among fathers, these findings were paralleled with respect to the impact of SWDL on perceived family resources but SWDL did not affect worries/mood.

scholarly journals Personal positioning of oncology patients in palliative care: a mixed-method study

2021 ◽  
Author(s):  
Hellen Luiza Meireles Silva ◽  
Pedro Henrique Martins Valério ◽  
Cristiano Roque Antunes Barreira ◽  
Fernanda Maris Peria
Keyword(s):  
Palliative Care ◽  
Mixed Method ◽  
Structural Equation ◽  
Structural Equation Models ◽  
Test Quality ◽  
Oncology Patients ◽  
Cross Sectional ◽  
C 30 ◽  
Eortc Qlq ◽  
The Impact

Abstract Background The condition of advanced oncological disorders demands a complete health care, although attention has been predominant on physical aspects. To consider personal positioning entails other aspects when dealing with patients’ diseases – such as their existential aspects – expanding forms of care. This study aims to comprehend the personal positioning of oncology patients receiving palliative care. Methods This is a cross-sectional, convergent parallel mixed-methods study. Seventy-one oncology patients in palliative care cooperated with this study, 14 of whom participated in a qualitative approach and 56 in a quantitative approach only. In the former approach, we conducted a phenomenological interview and, in the latter, we used tools to measure meaning of life (PIL-Test), quality of life (EORTC QLQ C-30), anxiety and depression (HADS), and to collect sociodemographic data. Data obtained through the interview were analyzed according to the principles of Classical Phenomenology, and the quantitative data were analyzed through generalized structural equation models. Results Our results showed that patients regained their focus on life, accentuating its possibilities and distancing themselves from the impact of their condition, such as imminent death, which was associated with giving up fighting depression. These signs were observed in 21% of the participants. This demands a tenacious fight that supports a positioning nurtured by sensitivity. Related to such position is the religious belief in life continuation, together with their awareness of the meaning of their own lives. Additionally, we found a direct association between purpose in life and an increase in the scores of functional scales (p < 0.01) and a decrease in scores of symptoms (p < 0.01), anxiety (p = 0.02) and depression (p < 0.01). The last elements to appear and structure the patients’ experience were their intense will to live and the value of life. Conclusions Through the complementarity of a mixed-method approach, this study acknowledged the existential positioning of oncology patients in palliative care that may help in more comprehensive and real treatment plans, contributing for humanization in this area.

scholarly journals Patients’ evaluations of patient safety in English general practices: a cross-sectional study

2017 ◽  
Vol 67 (660) ◽  
pp. e474-e482 ◽  
Author(s):  
Ignacio Ricci-Cabello ◽  
Kate S Marsden ◽  
Anthony J Avery ◽  
Brian G Bell ◽  
Umesh T Kadam ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Healthcare Delivery ◽  
Patient Activation ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
The North ◽  
Patient Reported ◽  
General Practices

BackgroundDescription of safety problems and harm in general practices has previously relied on information from health professionals, with scarce attention paid to experiences of patients.AimTo examine patient-reported experiences and outcomes of patient safety in primary care.Design and settingCross-sectional study in 45 general practices across five regions in the north, centre, and south of England.MethodA version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire was sent to a random sample of 6736 patients. Main outcome measures included ‘practice activation’ (what a practice does to create a safe environment); ‘patient activation’ (how proactive are patients in ensuring safe healthcare delivery); ‘experiences of safety events’ (safety errors); ‘outcomes of safety’ (harm); and ‘overall perception of safety’ (how safe patients rate their practice).ResultsQuestionnaires were returned by 1244 patients (18.4%). Scores were high for ‘practice activation’ (mean [standard error] = 80.4 out of 100 [2.0]) and low for ‘patient activation’ (26.3 out of 100 [2.6]). Of the patients, 45% reported experiencing at least one safety problem in the previous 12 months, mostly related to appointments (33%), diagnosis (17%), patient provider communication (15%), and coordination between providers (14%). Twenty-three per cent of the responders reported some degree of harm in the previous 12 months. The overall assessment of level of safety of practices was generally high (86.0 out of 100 [16.8]).ConclusionPriority areas for patient safety improvement in general practices in England include appointments, diagnosis, communication, coordination, and patient activation.

scholarly journals The Impact of Workaholism on Nurses’ Burnout and Disillusion

2018 ◽  
Vol 11 (1) ◽  
pp. 77-88 ◽  
Author(s):  
Marcello Nonnis ◽  
Davide Massidda ◽  
Stefania Cuccu ◽  
Claudio G. Cortese
Keyword(s):  
At Risk ◽  
Structural Equation ◽  
Structural Equation Models ◽  
Well Being ◽  
Self Report ◽  
Cross Sectional ◽  
Ongoing Research ◽  
South Italy ◽  
The Impact ◽  
The Relationship

Background:The literature has shown that workaholism acts at the root of burnout, but research regarding these constructs in the nursing profession is scant. Similarly, little attention has been paid to the impact of workaholism on disillusion, which is a dimension of burnout linked to professional vocation.Objectives:Contribute to the ongoing research on the relationship between workaholism and burnout among nurses. Moreover, this study considers disillusion as a dimension to be considered when investigating the relationship between workaholism and burnout, since nursing entails professional vocation.Method:The study followed a cross-sectional design. 614 nurses of six hospitals in South Italy have compiled two Self-report questionnaires: the Dutch Utrecht WorkAholism Scale (workaholism - Italian version) and the Link Burnout Questionnaire (burnout). Part of the group of subjects was diagnosed with both syndromes or considered at risk of developing them. The impact of workaholism on burnout was examined using Structural Equation Models for each variable.Results:More than 26% of the nurses are affected by burnout whereas 21% are workaholics. Working excessively proved to be a good predictor of both psychophysical exhaustion and disillusion.Conclusions:Nurses are at risk of workaholism and burnout. The study shows that workaholism is a predictor of nurses’ burnout, in particular working excessively (a dimension of workaholism) affects their psychophysical well-being and professional vocation.

scholarly journals Influence of VFR Tourism on the Quality of Life of the Resident Population

2020 ◽  
Vol 11 (20) ◽  
pp. 60-73
Author(s):  
Alfonso González Damián ◽  
Alma Rosa Macías Ramírez
Keyword(s):  
Quality Of Life ◽  
Structural Equation ◽  
Structural Equation Models ◽  
Local Population ◽  
Well Being ◽  
Economic Benefits ◽  
Cross Sectional ◽  
Tourism Destinations ◽  
The Impact

The aim of this document is to report on characteristics of VFR travel, the perceived impacts of these trips, and their effects on the quality of life of the resident community. Cozumel, an international insular tourist destination in Mexico, is taken as case of study. Data were obtained from a cross-sectional observational study, driven by survey conducted in Cozumel to characterize VFR trips, using an instrument that has been previously tested in other destinations and a composite scale was constructed to measure perceived quality of life by means of a survey administered to a sample of Cozumel residents. Structural equation models were used to test the influence of the social impacts perceived by the population on their quality of life. The movement of VFR travellers to Cozumel is significant, although their main expenses are not used in commercial accommodation. Community and economic impacts are perceived as significant by the population, whereas the impact on mobility and local transportation is perceived as negative. The direct and positive influence of economic benefits on the quality of life of local population was significant, whereas community-related and transportation-related impacts were significant only for residents who were not visited by friends or relatives. The main implications of these findings lead to the need to examine, in greater detail, the quality of life of residents in tourism destinations receiving VFR travelers. Thus, the main contribution of this paper, is to figure out that it is not the same to receive visitors than to observe others receiving them, not just in economic terms, but in terms of emotional and community well-being. This contrast is very likely to be confirmed in studies carried out in other international tourism destinations around the world.

scholarly journals Nature and type of patient-reported safety incidents in primary care: cross-sectional survey of patients from Australia and England

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042551
Author(s):  
Andrea L Hernan ◽  
Sally J Giles ◽  
Andrew Carson-Stevens ◽  
Mark Morgan ◽  
Penny Lewis ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Patient ◽  
Care Patient ◽  
System Level ◽  
Service Improvement ◽  
Cross Sectional ◽  
Positive Effects ◽  
Contributory Factors ◽  
Safety Incident ◽  
Patient Reported

BackgroundPatient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement.ObjectiveThe aim of this study was to characterise the nature of patient-reported safety incidents in primary care.DesignSecondary analysis of two cross sectional studies.ParticipantsAdult patients from Australian and English primary care settings.MeasuresPatients’ self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented.ResultsA total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent.ConclusionsThe nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement.

scholarly journals PROMIS Scales for Assessment of Persistent Post-COVID Symptoms: A Cross Sectional Study

2021 ◽  
Vol 12 ◽  
pp. 215013272110304
Author(s):  
Ravindra Ganesh ◽  
Aditya K. Ghosh ◽  
Mark A. Nyman ◽  
Ivana T. Croghan ◽  
Stephanie L. Grach ◽  
...  
Keyword(s):  
Health Status ◽  
Social Roles ◽  
Disease Process ◽  
Cross Sectional Study ◽  
Large Sample Size ◽  
Sectional Study ◽  
Cross Sectional ◽  
Data Set ◽  
Patient Reported ◽  
The Impact

Objective Persistent post-COVID symptoms are estimated to occur in up to 10% of patients who have had COVID-19. These lingering symptoms may persist for weeks to months after resolution of the acute illness. This study aimed to add insight into our understanding of certain post-acute conditions and clinical findings. The primary purpose was to determine the persistent post COVID impairments prevalence and characteristics by collecting post COVID illness data utilizing Patient-Reported Outcomes Measurement Information System (PROMIS®). The resulting measures were used to assess surveyed patients physical, mental, and social health status. Methods A cross-sectional study and 6-months Mayo Clinic COVID recovered registry data were used to evaluate continuing symptoms severity among the 817 positive tested patients surveyed between March and September 2020. The resulting PROMIS® data set was used to analyze patients post 30 days health status. The e-mailed questionnaires focused on fatigue, sleep, ability to participate in social roles, physical function, and pain. Results The large sample size (n = 817) represented post hospitalized and other managed outpatients. Persistent post COVID impairments prevalence and characteristics were determined to be demographically young (44 years), white (87%), and female (61%). Dysfunction as measured by the PROMIS® scales in patients recovered from acute COVID-19 was reported as significant in the following domains: ability to participate in social roles (43.2%), pain (17.8%), and fatigue (16.2%). Conclusion Patient response on the PROMIS® scales was similar to that seen in multiple other studies which used patient reported symptoms. As a result of this experience, we recommend utilizing standardized scales such as the PROMIS® to obtain comparable data across the patients’ clinical course and define the disease trajectory. This would further allow for effective comparison of data across studies to better define the disease process, risk factors, and assess the impact of future treatments.

scholarly journals Investigating the Effective Factors on Family Physicians’ prescriptions

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Ghanbarzadegan ◽  
Z Kavosi ◽  
S Karimi ◽  
M Peyravi ◽  
A Ghorbanian ◽  
...  
Keyword(s):  
Financial Incentives ◽  
Structural Equation ◽  
Behavioral Control ◽  
Family Physicians ◽  
Quality Criterion ◽  
Behavioural Control ◽  
Perceived Behavioral Control ◽  
Cross Sectional ◽  
Perceived Behavioural Control ◽  
The Impact

Abstract Introduction The physicians are responsible for prescribing medicine rationally. Physician's awareness of prescribing guidelines can lead to the selection of the most effective, appropriate and effective measures to the improved prescription. This study aim is to determine the factors influencing drug prescribing behaviour in family physicians. Methods This cross-sectional study was conducted in 2016 on a case study including 150 family physicians from Shiraz City who were selected by systematic random sampling method. A questionnaire related to the behaviour of prescribing physicians was used based on the theory of planned behaviour to collect data. The validity of the questionnaire was confirmed by the experts' opinion and its reliability was confirmed by calculating the Cronbach's alpha. The data were analyzed using structural equation modelling (SEM) by SPSS and Smart PLS software. Results It was specified that 39.3% of Shiraz family physicians have prescribed medicines for their most patients (61-70%) during the last month. Furthermore, 60% of physicians have prescribed for about 20% of their patients without any examination. In addition, 63% of doctors have repeated prescription for about 20% of patients with chronic disease. Based on the obtained results of the Research Structural Equation Model, none of the four considered variables explains changes in physicians' behaviour regarding prescribing. Although, “mental and perceived behavioural control” explain 30.2% of the changes in the intention of prescribing medication of family physicians in Shiraz. Conclusions The family physicians' behaviour in prescribing medicine shows the impact of factors such as the patient's request, as well as the role of the patients and colleagues pressure for prescribing medicine as a quality criterion for their practice. norms of mental and perceived behavioural control are effective in explaining the purpose of prescribing. Key messages Policymakers should implement policies to develop physicians’ behavior and logical prescription by education, financial incentives; consequently. Mental and perceived behavioral control are effective in explaining the purpose of prescribing.

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