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At least 19 recordsLinked to original sources
PubMed1979

Eliminating office architectural barriers to dental care of the elderly and handicapped.

Methods by which the most common architectural barriers to dental care for the elderly and handicapped can be overcome are described. Some physiological and medical conditions that necessitate special provisions in location and design of the office management of patients have been described. The consequences of accessibility have been discussed and suggestions for management of elderly and handicapped patients are presented.

Aged↗
PubMed2026

A multi-analyte cfDNA-based blood test for early detection of hepatocellular carcinoma.

BACKGROUND & AIMS: Patients at high risk for hepatocellular carcinoma (HCC) are recommended to undergo biannual abdominal ultrasound surveillance; however, ultrasound has low sensitivity for small HCC nodules and is associated with poor adherence. To address these limitations, the multianalyte HelioLiver Dx blood test was developed to aid in the detection of HCC in patients with cirrhosis who are at high risk for HCC. METHODS: The performance of the HelioLiver Dx test and ultrasound for the detection of HCC in adults with cirrhosis was evaluated in a cross-sectional, prospective, blinded, multicenter validation study. All participants provided blood specimens for the HelioLiver Dx test and underwent ultrasound. All participants also underwent multiphasic MRI, which served as the reference standard for determining HCC status. RESULTS: Of 1,268 evaluable participants, 46 (3.6%) were considered to have HCC as determined by MRI, with many (46%) having small HCC lesions ≤2 cm in diameter. The HelioLiver Dx test had a sensitivity of 47.8% (95% CI 32.9-63.1) for all HCC lesions and 28.6% (95% CI 11.3-52.2) for HCC lesions ≤2 cm. In contrast, ultrasound demonstrated a lower sensitivity of 28.3% (95% CI 16.0-43.5) for all HCC lesions and failed to detect any (0%; 95% CI 0.0-16.1) HCC lesions ≤2 cm. The specificity of HelioLiver Dx and ultrasound were 87.6% (95% CI 85.6-89.4) and 93.9% (95% CI 92.5-95.2), respectively. The HelioLiver Dx test met prespecified co-primary endpoints for superior sensitivity and non-inferior specificity compared to ultrasound. CONCLUSION: Compared with ultrasound and alpha-fetoprotein, the HelioLiver Dx test identified more HCC lesions overall, including more small lesions. A convenient and accurate blood-based test may improve HCC surveillance by facilitating earlier detection and reducing patient barriers to testing. GOV IDENTIFIER: NCT03694600 IMPACT AND IMPLICATIONS: There is a significant, unmet clinical need for more sensitive and accessible methods for the early detection of hepatocellular carcinoma (HCC) in high-risk patient populations. The current study is the first blinded, multicenter, prospective study to evaluate the performance of a multianalyte blood test compared to abdominal ultrasound for the detection of HCC among patients with cirrhosis. The multianalyte HelioLiver Dx test met prespecified co-primary endpoints for superior sensitivity and non-inferior specificity compared to ultrasound for detection of HCC lesions. The availability of a more accessible, convenient and sensitive blood test to aid in the detection of HCC may improve utilization and consequently clinical outcomes for high-risk patients via reduction of care barriers and improved early HCC detection. CLINICALTRIALS: gov identifier: NCT03694600.

Humans↗
PubMedDate not supplied

Effect of economic barriers to medical care on patients' noncompliance.

The post-hospital care of 290 patients with selected chronic conditions of a specific severity who were discharged over a 3-month period from a general hospital in Halifax, Canada, was studied. The majority of the patients were married. The average age of the men was 59.2 years and of the women 58.1. More than half of the patients belonged to the low socioeconomic group earning between $1,000 and $6,999 a year. Their average period of education was 8.4 years. Interviews with the patients about their compliance with physicians' orders revealed that 40.4 percent had not complied with one or more of their physician's recommendations. Lack of compliance was related to age, marital status, education, income, and severity of disease. It was also associated with high dosages of medicine and multiple prescriptions. Cost barriers constituted a significant factor in noncompliance.

Adult↗
PubMed1979

Utilization of health care: the Laredo migrant experience.

In 1973, three groups of randomly selected migrant labor families resident in Laredo, Texas were enrolled in a prepaid health insurance study. A study was implemented to determine the kinds and costs of medical care used by Mexican American migrant labor families in their homebase and travel areas where financial barriers to care were eliminated or reduced. At the end of three years it was found that the study population used ambulatory services about one-half as much as the general U.S. population while hospital use approached regional norms. The differences between homebase and out-of-area use are highlighted, and the reported failure to use any public facilities outside of Laredo is discussed.

Adolescent↗
PubMed2026

Facilitators and Barriers to Volunteers' Involvement in Palliative Care: A Qualitative Meta-Synthesis.

OBJECTIVE: This study aims to systematically synthesize qualitative evidence on facilitators and barriers to volunteer involvement in palliative care services, providing insights to inform strategies for strengthening volunteer support systems. METHODS: PubMed, Web of Science, Embase, Cochrane Library, Medline, EBSCO, ProQuest, China National Knowledge Infrastructure, Wanfang, VIP, and Sinomed were searched from inception to December 2025 to identify qualitative studies examining factors influencing volunteer participation in palliative care. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data were analyzed using Thomas and Harden's thematic synthesis approach and managed using NVivo 12.0 software, following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. RESULTS: Thirty-one studies involving 1042 participants were included, yielding 68 findings. Facilitators included intrinsic motivation and meaning-making at the individual level; supportive relationships and teamwork at the interpersonal level; structured support and professional recognition at the organizational level; social recognition and resource integration at the community level; and institutional safeguards and governmental incentives at the policy level. Barriers included emotional burden and limited competencies at the individual level; relationship conflicts and insufficient collaboration at the interpersonal level; management deficiencies at the organizational level; community resource imbalances at the community level; and inadequate regulations and incentives at the policy level. CONCLUSION: Volunteer participation in palliative care is influenced by multiple interacting factors. Strengthening training and support systems, enhancing team collaboration, and improving institutional frameworks may help sustain volunteer engagement and improve the quality of palliative care services.

Palliative Care↗
PubMed1979

A survey of preceived oral health needs of homebound patients.

1. While almost 60 percent of all patients reported dental needs, it is assumed that actual needs were in fact considerably higher. Problems relating to dentures were the most freqeuntly expressed complaint. 2. A strong relation existed between the ability of homebound patients to get to a dentist and the time elapsed since last dental visit. Number of teeth was a significant determinant in frequency of seeking care. Persons with teeth or dentures sought treatment more often than those who were edentulous. Pain was the only variable for which a difference was noted between the two groups in the effect on time of last dental visit. 3. The study revealed an inaccessibility of dental care for the majority of patients confined to their homes. Ability to get to the dentist was identified as a major barrier to care for the homebound. The delivery of dental services to such patients in their immediate surroundings, by specially trained dental professionals using mobile units, must therefore be seriously considered as a means for improving access to care for this population.

Aged↗
PubMed2026

Status of dementia care among healthcare practitioners in Nigerian tertiary hospitals: a cross-sectional study.

BACKGROUND/OBJECTIVES: Dementia is an escalating public health concern globally. This study evaluated the knowledge, attitudes, practices, and perceived barriers to dementia care among healthcare practitioners in Nigerian tertiary hospitals, aiming to identify practitioner-related sociodemographic predictors and systemic barriers affecting dementia care delivery. METHODS: We collected data from May 2024 to May 2025 for this cross-sectional study in 12 purposively selected tertiary hospitals across Nigeria's six geopolitical zones. Participants included physicians, nurses, pharmacists, and other professionals involved in geriatric psychiatric care. Using multistage and convenience sampling, 394 respondents were recruited (response rate: 99.5%). Data were collected via a validated Dementia Care Practice Questionnaire (Cronbach's α = 0.84) and analyzed with SPSS v22. Descriptive statistics, Chi-square tests, and odds ratios (ORs) identified associations (significance: p ≤ 0.05). RESULTS: Of 394 respondents, 51.5% were aged ≥40 years, and 54.8% were female. While 62.9% demonstrated adequate knowledge, negative perceptions (51.3%) and attitudes (56.9%) were common. Despite this, 71.3% reported engagement in dementia care, and 75.6% demonstrated appropriate professional help-seeking behaviour when confronted with dementia care challenges. Practitioner-reported barriers included limited training opportunities, geographical barriers affecting patient access to dementia services, and inadequate staffing. Predictors of desirable care practices among healthcare practitioners included age ≥40 years, female gender, Christian affiliation, and ≥5 years of professional experience. CONCLUSION: Although many healthcare practitioners are involved in dementia care, gaps in perceptions, attitudes, and structural support persist. Interventions should focus on targeted training, system strengthening, and policy reform to improve dementia care outcomes.

Barriers to care↗
PubMed2026

IMPROVE kidney care: perspectives from marginalised people with CKD and risk factors for CKD on access to, and experience of, kidney care services: a cross-sector collaborative exploration, employing qualitative approaches.

BACKGROUND: Access to, and experience of, chronic kidney disease (CKD) care is inequitable-with barriers to accessing quality care for marginalised groups. We conducted an exploratory study employing qualitative approaches to understand the factors that influence access to, and experience of, healthcare services for marginalised people with CKD and at risk of CKD. METHODS: An exploratory study employing qualitative approaches was conducted as a cross-sector collaboration between kidney care services and an activist, antiracist community-based research and social justice organisation (Mabadiliko Community Interest Company (CIC)). Two groups were recruited: 1) those with risk factors for CKD or early-stage CKD, and 2) people who presented late to kidney care services. Semi-structured interviews were co-designed with people with lived experience and conducted by Mabadiliko CIC. Thematic analysis was undertaken, with themes refined by participants. RESULTS: Twenty interviews were undertaken with a diverse cohort of participants. Knowledge and awareness of CKD was limited, and compounded by a lack of delivery of accessible, culturally congruent information. Significant barriers to accessing kidney care exist for marginalised people, including people who are from global majority ethnic backgrounds, Disabled people, and/or people experiencing material hardship. These barriers are compounded by interpersonal discrimination and paternalistic power dynamics within healthcare interactions. CONCLUSION: This study captures the experiences of marginalised people at different stages of their journey with CKD, in accessing and engaging with kidney care services. Participants faced a complex array of challenges, highlighting opportunities for multi-level intervention. We outline recommendations to address these issues, co-developed with participants.

chronic kidney disease↗
PubMed1979

Psychiatric manpower ratios. A beguiling numbers game?

Many characteristics of California's counties that correlate with physician-population ratios also correlate with psychiatrist-population ratios, with their changes through time and with rural counties' ability to attract psychiatrists. These same county characteristics seem to influence the uneven distribution of lawyers throughout the state, a fact that should help physicians help legislators understand problems in attempting to equalize manpower distribution. California's relatively high psychiatrist-population ratio and the presence of counties that are statistically anomalous should preclude the application of these findings to other states. Despite government interest in psychiatrist-population ratios as a device to estimate manpower needs, these ratios are a poor measure of access to services. Barriers to care such as lack of private insurance coverage and Medicaid and Medicare restrictions appear more powerful than uneven manpower distribution. Proposals for influencing psychiatrists' distribution should be compared with other methods of decreasing mental illness morbidity, such as mandating insurance coverage and increasing funds for preventive services and research.

Adult↗
PubMed1977

Argon laser photocoagulation of the posterior segment in pseudophakia.

A series of in vitro, in vivo, and clinical studies was performed to explore the safety and efficacy of argon laser and xenon arc photocoagulation in pseudophakia. The polymethylmethacrylate intracameral lens (Fyodorov) proved resistant to photothermal decomposition and allowed transmission of therapeutically effective energy levels to the retina. The argon laser delivered through a slit lamp and contact lens optical system appears to be the preferred method for posterior segment photocoagulation in pseudophakia. On the basis of five-day tissue culture studies and clinical experience of two years, the intracameral lens does not appear to be a toxic or transmission barrier to careful argon laser photocoagulation.

Animals↗
PubMed2026

Evidence of parental care as a newly identified reproductive isolating barrier.

Variation in behavior can contribute to reproductive isolation by preventing gene flow among populations. Here, we tested the novel hypothesis that parental care, when dysregulated, can function as a reproductive isolating mechanism in three-spined stickleback fish (Gasterosteus aculeatus). In the typical "common" stickleback ecotype, males provide care to their offspring by fanning with their pectoral fins and defending their nest. In contrast, a divergent "white" stickleback ecotype has evolutionarily lost care and disperses embryos into the surrounding environment. We examined how paternal care from common, white, and F1 hybrid fathers influenced offspring survival. We detected no intrinsic incompatibilities in embryos, but F1 hybrid fathers exhibited dysregulated parental care that coincided with decreased survival of parented offspring. The increased offspring mortality may be explained by further dysregulation of feeding and parenting circuitry, as F2 hybrids exhibited significantly higher rates of post-fertilization filial cannibalism than common or white fathers. Additionally, despite strong divergence in nesting-building and courtship behavior, F1 hybrids achieved mating success at a similar rate as male commons and whites, suggesting that prezygotic barriers against hybrids may be weak. The observed postzygotic isolation, and potentially weak prezygotic isolation in lab-based studies, suggest that hybridization is likely occurring at low rates in the wild. Population genetic analysis supported this, as low proportions of putative hybrids were detected in sympatric sites. Together, these results may help explain why genetic divergence between these phenotypically distinct ecotypes is low and provide evidence that dysregulated parental behavior can act as a newly discovered postzygotic reproductive isolating barrier.

Reproductive isolation↗