A Systems Approach to Achieve Equity in Healthcare Research

Healthcare in the United States is inequitable. The consequence of inequity is that the burden of serious chronic disease, such as diabetes, falls disproportionately on populations experiencing health disparities, predominantly Black, Indigenous, and people of color. [1] The reasons for the inequity include the negative impact of the social determinants of health of individuals and families from these communities, being underrepresented as participants in clinical research, having limited access to technologies that support self-care, and a lack of researchers and clinicians from these same populations. [2] To achieve equity and fairness, there is a need for a paradigm shift in healthcare research and innovation based on improving access, trust, and self-efficacy [3] to convert new knowledge into positive health outcomes.

Blenderized tube feeding for children: an integrative review

ABSTRACT Objective: To analyze scientific evidence on the use of blenderized tube feeding in children regarding nutritional composition, family satisfaction, and health outcomes. Data source: Survey was conducted in the PubMed, Scopus, Embase, and Virtual Health Library (VHL) databases using the following search terms: blenderized tube feeding OR blended tube feeding OR homemade OR pureed AND enteral nutrition AND enteral tube. The methodological quality of the selected articles was evaluated using the Critical Appraisal Skill Programme and Hierarchical Classification of Evidence. Data synthesis: After analysis, 11 articles were included in the present review. Most studies demonstrated improvements in health outcomes and greater family satisfaction after replacing the commercial enteral feeding with blenderized tube feeding. Conclusions: When guided and monitored by the healthcare team, a blenderized tube feeding ensures an adequate nutritional composition. The use of this method is also associated with positive health outcomes such as reductions in gastrointestinal symptoms and hospitalizations. Moreover, a high frequency of family satisfaction was verified.%

Healthcare: action research with trans people living on the streets

ABSTRACT Objectives: to analyze the representations of healthcare provided to trans people living on the streets. Methods: ten women (three trans) and three cisgender men participated in this action research. Popular health education groups, focus groups, seminars and interviews were held, the data of which were organized in the software Nvivo®, submitted to content analysis and interpreted in the light of intersectionality theory. Results: healthcare was represented by the technical, relational, structural and citizenship dimensions. The relationship between gender and poverty determines the specific health needs of trans people living on the streets. Final Considerations: the need to expand conceptions and practices on healthcare to meet the specific health needs of trans people living on the streets was evidenced. Nursing, with competence and cultural sensitivity, can contribute to positive health outcomes and, consequently, break with the logic of exclusion, illness and poverty.

Applying Salutogenesis in the Workplace

This chapter presents models, measures, and intervention approaches that relate to the double nature of work and its salutogenic quality. Hereby, the view of Aaron Antonovsky is enhanced insofar that health-promoting, salutogenic job characteristics are not solely understood as mitigating the pathogenic effects of stressors at work but have a distinct effect on positive health outcomes. In the chapter, Antonovsky’s original model is first specified and simplified for the context of work. Next, Antonovsky’s line of thinking is related to frameworks researching job resources and demands. After a review of the prevalence of salutogenic measures in worksite health promotion, the point of making salutogenesis more visible in work-related research and practice is elaborated. This is illustrated with a practical example of a survey-feedback process promoting salutogenic work.

More that Childbirth: Doulas and their Expanding Role

The Doulas has become more frequent and relevant in the past years. Doulas, women who primarily provide social support during childbirth, have been associated with several positive health outcomes. But the role of Doulas has fast developed in many other ways of caring that includes more than just childbirth.

Sustainable Indigenous housing in regional and remote Australia

This research explores what is required for sustainable Indigenous housing in remote Australia to deliver positive health outcomes, so that housing stock is maintained at high levels and is designed with climate change in mind.

Conceptualizing Drug Addiction and Chronic Pain through a Biopsychosocial Framework to Improve Therapeutic Strategies

The recent surge in opioid-related deaths has brought poor pain management practices to the forefront of our nation’s collective consciousness. However, improving treatments for chronic pain, substance use disorders (SUD), and comorbid expression of both requires a better understanding of the pathophysiology involved in their development. In this chapter, the authors present the argument that chronic pain and SUD can be conceptualized similarly from a biopsychosocial perspective to inform a better approach to treatment. The authors describe the common neurobehavioral mechanisms of SUD and chronic pain, then discuss the efficacy of several psychotherapeutic methods employed to combat chronic pain, addiction, and related disorders. Such methods may contribute to positive health outcomes in managing chronic pain and curbing drug addiction by reducing the role of opioid analgesics for long-term pain management.

Families as support and burden: A mixed methods exploration of the extent to which family identification and support predicts reductions in stress among disadvantaged neighbourhood residents

Stronger family relationships predict positive health outcomes: a relationship that is partially due to the range of emotional, practical and informational support that families can provide. Yet not all families possess these resources. A survey study in a disadvantaged community in Nottingham, UK ( N = 142) demonstrated that family identification positively predicts ability to cope with financial stress, but that this relationship is moderated by whether family support is present or absent. Semi-structured interviews with 10 members of different families from the same community shed further light upon the nature of this relationship: individuals report that they tend to turn to their family rather than friends or community services in times of financial hardship, even though their family are unlikely to be able to support them effectively, and that this is often due to feelings of embarrassment or finance-related stigma. Our findings highlight the complex role that families can play in finance-related issues, as well as the need to encourage individuals to seek financial support from sources which provide effective (rather than emotionally comfortable) assistance.

“It Is a Very Emotional Topic for Me”—Managing Breastfeeding Problems among German Mothers: A Qualitative Approach

Breastfeeding is associated with positive health outcomes for both child and mother. Nevertheless, some women experience breastfeeding problems which commonly lead to early cessation, or not starting breastfeeding at all. Our aim was to explore how women that have difficulties in breastfeeding perceive their situation and how they actively manage it. We conducted semi-structured interviews with 15 mothers living in Germany who had experienced breastfeeding problems. The interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Breastfeeding problems occurred due to different reasons and had a huge impact, as evidenced in the four main themes of the findings: individual situation, managing the situation, perceived consequences for relations, feelings, and potential future pregnancies, and perceived health consequences for the mother. They frequently experienced negative emotions, including psychological distress and mental health problems, with perceived negative consequences for the mother–infant-bonding. Trying to actively manage the situation and availability of social support seemed to have a relieving effect, whereas confrontation and lack of understanding worsened the situation. Breastfeeding problems and the inability to breastfeed can have a great influence on maternal well-being. These can affect different aspects of a mother’s life, including the attachment to the child. Providing support for actively managing the situation and supporting the exchange of experience between mothers who perceive breastfeeding problems may help mothers to better deal with their situation. Our findings may help health professionals to understand what these mothers feel and how they can support these women in a sensitive way.

Group Social Support Facilitates Adoption of Healthier Behaviors Among Black Women in a Community-Initiated National Diabetes Prevention Program

The aim of this study was to better understand facilitators and barriers of the early adoption of healthy eating and physical activity behaviors among Black women participating in a community-based, community-initiated diabetes education program. We held focus groups with participants ( N = 14) ages 24 to 90 years. Participants were recruited from a multisite, community-based diabetes prevention program in the Southeastern United States. Data were collected in March and June of 2017. Barriers and facilitators of change were categorized using the socioecological model with interpersonal, intrapersonal, community, and environmental factors serving as the foundation for thematic content. Participants reported the adoption of several behavioral changes resulting in positive health outcomes. They also identified several facilitators and few barriers to initial behavior change on participating in the diabetes prevention program. The greatest facilitator was interpersonal, while the greatest barriers were community and/or environmental. Understanding the factors that improve or impede the successful adoption of health behaviors among Black women participating in a behavioral lifestyle program will allow us to develop stronger, more tailored interventions that provide the greatest impact to assist in improving weight loss outcomes and reducing the burden of diabetes among Black women.