INTRODUCTION: As the population ages, patient complexity is increasing, intensifying the demand for well-resourced, coordinated care. A deeper understanding of the factors contributing to this complexity is essential for optimising resource allocation. This study evaluates the prevalence of complex care needs in Singapore's primary care settings and identifies the factors associated with these needs. METHOD: Using a qualitative study design, we developed a patient complexity questionnaire to assess how Singapore family physicians recognise patient complexity. Sixty-nine experienced primary care physicians applied this tool to assess patient encounters, categorising each as "routine care" (RC), "medically challenging" (MC), or "complex care" (CC). We compared the care needs across these categories and used mixed-effects multinomial logistic regression to determine the independent predictors of complexity. RESULTS: Of the 4327 encounters evaluated, 15.0% were classified as CC, 18.5% as MC, and 66.4% as RC. In both CC and MC encounters, the most common medical challenges were polypharmacy (66.2% in CC, 44.9% in MC); poorly controlled chronic conditions (41.3% in CC, 24.5% in MC); and treatment interactions (34.4% in CC, 26.0% in MC). Non-medical issues frequently identified included low health literacy (32.6% in CC, 20.8% in MC); limited motivation for healthy lifestyle behaviours (27.2% in CC, 16.6% in MC); and the need for coordinated care with hospital specialists (24.7% in CC, 17.1% in MC). The top 3 independent predictors of complexity included mobility limitations requiring assistance (odds ratio [OR] for requiring wheelchair/trolley: 7.14 for CC vs RC, 95% confidence interval [CI] 4.74-10.74); longer consultation times with physicians (OR for taking >20 minutes for doctor's consultation: 3.96 for CC vs RC, 95% CI 2.86-5.48); and low socioeconomic status (OR for living in 1- or 2-room HDB flats: 2.98 for CC vs RC, 95% CI 1.74-5.13). CONCLUSION High care needs, encompassing both CC and MC encounters, were prevalent in primary care interactions. These findings highlight that relying solely on chronic disease count is insufficient to capture the full spectrum of patient complexity.
Singapore/epidemiology* ; Humans ; Primary Health Care/statistics & numerical data* ; Male ; Female ; Middle Aged ; Aged ; Adult ; Surveys and Questionnaires ; Prevalence ; Polypharmacy ; Qualitative Research ; Chronic Disease/therapy* ; Logistic Models

BACKGROUND: Only prospective cohort studies can capture changes in work conditions and their effects on health. Such studies are rare in bus drivers, despite their high rates of injuries and diseases. The three existing cohorts have limited exposure data, collected at baseline and thus uninformative on exposure and exposure-effect dynamics. Therefore, we aimed to develop the Swiss Transport Personnel Health Cohort (TRAPHEAC) and to anticipate and prevent potential bias. METHODS: To set up the study protocol, we first organized the stakeholder consultation and available data inventory. Second, we mapped the exposure-outcomes pairs to list the most prevalent occupational hazards, and conducted exposure measurement campaigns. Third, we built the Swiss Bus-Exposure Matrix for physical-chemical hazards and Bus-Ergonomics Matrix for visual and biomechanical constrains. These matrices contain 705 bus models operated in Switzerland since 1980 and enable assessing current and past exposure when merged with bus drivers' work histories. RESULTS: We opted for an original study design combining prospective cohort part starting at 2024 and a retrospective part with nested case-control studies. Bus drivers will be invited through three complementary channels: unions, companies, and social media. The eligibility screening, information, and consent form signature and registration will be conducted using the study web-site modules. Registered bus drivers will first receive a comprehensive inclusion questionnaire, then a yearly follow-up questionnaire to assess and update the drivers' work histories. Validated self-reported questionnaires will be used for assessing additional health outcomes (e.g., stress, sleep problems, musculoskeletal disorders, burnout) and individual, occupational and live-style related factors (e.g., personality, ICT use, physical activity). Hospital records (with diagnosed diseases, diagnosis dates and treatments) centralized since 2000 by the Swiss Federal Statics Office will be used for assessing disease prevalence, incidence and case-control status. Advanced statistical analysis will be conducted to address etiological and methodological questions (e.g., individual and joint causal effects of multiple exposures and exposure components; time-varying exposure and outcome variables and confounders mixtures). CONCLUSIONS The yearly assessment of both exposure and health outcomes should enable capturing changes in work conditions and their effects on bus drivers' health and well-being over time and facilitate the tailoring, implementation and evaluation of preventive interventions.
Humans ; Switzerland/epidemiology* ; Prospective Studies ; Occupational Exposure/statistics & numerical data* ; Occupational Diseases/epidemiology* ; Cohort Studies ; Motor Vehicles ; Research Design ; Retrospective Studies ; Case-Control Studies ; Occupational Health ; Adult ; Male ; Female

BACKGROUND: Supporting the mental health of researchers is essential to maintaining human resources and advancing science. This study investigated the association between Japanese medical researchers' perceptions of research evaluation processes and their psychological well-being. METHODS: We performed a web-based self-administered questionnaire survey. The questionnaires were distributed to each academic society through the Japanese Association of Medical Sciences from December 2022 to January 2023. These questionnaires targeted medical researchers. Exposure was the medical researchers' perceptions of quantitative indicators for evaluating medical research and researchers. The outcome was psychological well-being, measured using the Japanese version of the World Health Organization-Five Well-Being Index (WHO-5). Multivariable-adjusted logistic regressions were conducted to investigate the association between individual attitudes toward research evaluation and psychological well-being. Stratified analyses by research fields, i.e., clinical, basic, and social medicine, were also performed. RESULTS: A total of 3,139 valid responses were collected. After excluding 176 responses from research fields of other than clinical, basic, or social medicine, 2,963 researchers (2,185 male, 737 female, and 41 other) were analyzed. Prevalence of poor well-being (WHO-5 score <13) was 28.3% in the researchers. The highest number of medical researchers was in clinical medicine (n = 500) followed by basic medicine (n = 217) and social medicine (n = 121). Medical researchers who considered research funding slightly important/not important for researcher evaluation had poorer psychological well-being than those who considered it especially important (slightly important: adjusted odds ratio (aOR) 1.33, 95% confidence interval (CI) 1.03-1.71; not important: aOR 1.53, 95%CI 1.10-2.12). This tendency was stronger among basic medical researchers than clinical or social medical researchers. The research field significantly modified the relationship between research funding received and interaction with poor psychological well-being both additively (P = 0.030) and multiplicatively (P = 0.024). CONCLUSIONS The discrepancy between medical researchers' attitudes toward research evaluation and the current state of research evaluation in their research community may worsen their psychological well-being. The influence of this discrepancy differs among clinical, basic, and social medicine. Appropriate evaluation of medical research and researchers in each field can facilitate improving their psychological well-being via the resolution of this discrepancy.
Humans ; Japan ; Female ; Male ; Cross-Sectional Studies ; Adult ; Research Personnel/statistics & numerical data* ; Middle Aged ; Biomedical Research ; Surveys and Questionnaires ; Mental Health ; Psychological Well-Being ; East Asian People

OBJECTIVE: To study the working experience of COVID-19 care nurses. METHODS: Twenty two nurses taking care of COVID-19 patients were interviewed by means of descriptive phenomenology. All the data were transcribed and recorded, and then processed into WORD documents. The Colaizzi 7 footwork was used to classify, encode, establish nodes and extract themes based on Nvivo11.0 software. RESULTS: Two main themes were extracted: one is the positive feelings of nurses, including the sense of professional mission and pride, the sense of achievement and happiness, the improvement of self-worth and ability, the powerful support system and the power of role models; the other is the negative experience of nurses, including the worry and anxiety at work, the lack of experience and trust, the difficulty of work, and the inconvenience of isolating life. CONCLUSIONS s While fully affirming the work value of nurses, it is necessary for the society, hospitals and patients to give extensive and continuous support, care and respect to nurses, so as to stimulate their working enthusiasm and sense of professional achievement. Hospital managers need to implement all kinds of security work, meet the safety needs of nurses, pay attention to the physical and mental health of nurses, strengthen the training of nursing talents for critical and severe diseases and infectious diseases, improve the allocation of human resources, and enhance the ability of material allocation and reserve for major health events, so as to make adequate preparations for coping with public health events in the future.
Betacoronavirus ; Coronavirus Infections ; Hospitals ; statistics & numerical data ; Humans ; Nurses ; statistics & numerical data ; Pandemics ; Pneumonia, Viral ; Qualitative Research ; Workplace ; statistics & numerical data

BACKGROUND: To let the early elderly live well, understanding how lifestyle and psychosocial factors related to a decline in competence in daily living is important. METHODS: We investigated the associations between lifestyle and psychosocial factors at age 64 years and a decline in the Tokyo Metropolitan Institute of Gerontology Index of Competence score of ≥ 2 points at age 70 years among the participants in comprehensive medical check-ups living in a city in Japan. Multivariable logistic regression analyses were performed separately for men and women. RESULTS: Of the 1113 eligible men and 1203 eligible women, 110 men and 80 women showed a deteriorated competence in daily living during the 6 years. In men, risk was increased with ≥ 2 nighttime awakenings (multivariable odds ratio [mOR] 2.14, 95% confidence interval [CI] 1.19-3.86) and living alone (mOR 4.68, 95% CI 1.22-18.0), whereas risk was significantly decreased with a medium or fast gait (mOR 0.37 and 0.21, 95% CI 0.21-0.67 and 0.08-0.58) and high academic achievement (mOR 0.32 and 0.43, 95% CI 0.19-0.53 and 0.25-0.72). In women, risk was decreased with high life satisfaction (mOR 0.39, 95% CI 0.16-0.91) and participation in community activities (mOR 0.50, 95% CI 0.29-0.86) but increased with depressive mood (mOR 1.86, 95% CI 1.09-3.18). CONCLUSION Living alone for men and low life satisfaction for women at age 64 years were markedly associated with the risk of a subsequent declining competence in daily living.
Activities of Daily Living ; psychology ; Aged ; Cohort Studies ; Community-Based Participatory Research ; Female ; Geriatric Assessment ; Healthy Aging ; Humans ; Independent Living ; psychology ; statistics & numerical data ; Japan ; Life Style ; Male ; Middle Aged ; Physical Functional Performance ; Protective Factors ; Risk Factors ; Surveys and Questionnaires

PURPOSE: The purpose of this qualitative study was to identify the nature of precocious puberty and to explore what it means in primary schools.METHODS: The participants of this phenomenological study were nine primary school girls who were diagnosed with precocious puberty and experienced hormone therapeutics, applying a convenience sampling method. Data were collected from July 2017 to January 2018 through individual in-depth interviews of the participants, including gestures, facial expressions and nonverbal means. The data analysis followed the method of Giorgi.RESULTS: The study identified 37 concepts, 12 clusters, and five themes from experiences of precocious puberty. The essential five themes were as follows: ‘ashamed and concealing experience’, ‘there is no therapeutics option’, ‘difficulties in the process of therapeutics’, ‘difficulties in daily life’, and ‘ambivalence toward therapeutics’.CONCLUSION: The findings of this study indicate physical, psychological and social difficulties faced by girls with precocious puberty. Based on this results of the study, it is necessary to develop nursing intervention programs focusing on healthy growth and development for children with precocious puberty.
Child ; Facial Expression ; Female ; Gestures ; Growth and Development ; Humans ; Methods ; Nursing ; Puberty, Precocious ; Qualitative Research ; Statistics as Topic

PURPOSE: This qualitative study aimed to develop a substantive theory of the process of adaptation to motherhood in Central Asian-Korean immigrants to Korea.METHODS: Individual, in-depth interviews were conducted from July to September 2017, with 18 women who emigrated of Korean ethnicity from Central Asia to Korea, and took care of their baby for at least a year after their first delivery in Korea. The interviews were audio-recorded and transcribed verbatim. Data from the transcriptions were analyzed through Strauss and Corbin's grounded theory method, and data analysis was conducted simultaneously with data collection.RESULTS: As a result of categorizing the interview data through the process of open coding, 10 categories, with 31 subcategories and 102 concepts were drawn, and “growth as a Central Asian-Korean mother in an unfamiliar, historical hometown” was found to be the core category of the process of adaptation to motherhood in Central Asian-Korean immigrants to Korea.CONCLUSION: A characteristic of the process of adaptation to motherhood in Central Asian-Korean immigrants to Korea, drawn from this study, is that it differs according to the level of initiative to carry out interaction strategies, and the use of various supportive social resources. The findings indicate the need for Medicare eligibility adjustment for antenatal care, the extension of the visa renewal period during childbirth, the development of web- or mobile application-based educational programs in Russian language, and the establishment of integrated visiting healthcare services, community service resources, and policy support to enable these women to utilize various supportive social resources.
Adaptation, Psychological ; Asia ; Clinical Coding ; Data Collection ; Delivery of Health Care ; Emigrants and Immigrants ; Female ; Grounded Theory ; Humans ; Korea ; Medicare ; Methods ; Mothers ; Parturition ; Qualitative Research ; Social Welfare ; Statistics as Topic

PURPOSE: The Iri station explosion that occurred in 1977 was a major social disaster in Korea, caused by a fire in a train equipped with explosives. The purpose of this study was to investigate the social disaster adaptation experiences of railroad workers. METHODS: This study was based on qualitative research using phenomenological methodology. Participants were six railroad workers who experienced the Iri station explosion. Data were collected through in-depth interviews with individual workers from March to June, 2018. The data analysis method was based on Colaizzi's approach. RESULTS: Experiences of railroad workers were categorized into 12 themes and the following 6 theme clusters: (1) Anxiety due to the extreme vibration and crash, (2) Terror regarding the horrible situation that one cannot face, (3) Anger about the cause of the explosion and a sense of relief about survival, (4) Confusion regarding different rumors, (5) Various efforts to return to daily life, and (6) Trauma that continues to exist. CONCLUSION: The findings of this study recommend that railroad organizations and managers should pay attention to enhance disaster preparedness and develop organizational disaster coping guidelines for members. The results of this study can help us to better understand the various aspects of the Iri station explosion of 1977.
Anger ; Anxiety ; Disasters ; Explosions ; Explosive Agents ; Fires ; Korea ; Methods ; Qualitative Research ; Railroads ; Statistics as Topic ; Vibration

PURPOSE: The purpose of this study was to obtain research-based evidence on the relationships among general characteristics, family strength, self-control, and happiness among late school-aged children using a correlational research design. METHODS: The participants were 172 fifth- and sixth-grade students from two public elementary schools. Data were collected by employing structured questionnaires, including the Korean Family Strengths Scale for Strengthening Family II, a self-control scale, and a happiness scale. Data analysis was conducted using SPSS version 23.0. RESULTS: The level of happiness of late school-aged students showed significant correlations with family strength (r=.78, p<.001), and self-control (r=.59, p<.001). Family strength had a significant positive correlation with self-control (r=.55, p<.001). The factors with a significant impact on participants' happiness were family strength (β=.63, p<.001), self-control (β=.21, p<.001), exercise frequency, and self-perceived health. The total explanatory power of the model was 69%, and the explanatory power of family strength for the level of happiness was 61%, showing that the family strength was the most important factor that promoted happiness in late school-aged students. CONCLUSION: These findings imply that improving family strength is an important aspect of promoting happiness among late school-aged children. Interventions to strengthen late school-aged children's self-control are also necessary.
Child ; Family Characteristics ; Happiness ; Humans ; Research Design ; Self-Control ; Statistics as Topic

PURPOSE: This study was a qualitative study done to investigate the experience of role conflict by physician assistant nurses. METHODS: The basis for this study was qualitative research using the phenomenological method. Research participants were 10 physician assistant nurses. Data collection methodology was in-depth interviews. The interviews were conducted 1 to 2 times and each interview lasted within the range of 45 minutes to 2 hours. The data collection and analysis were carried out simultaneously and the Colaizzi (1978) methodology was adopted for data analysis. RESULTS: The results showed 46 significant statements, 13 meaningful statements, 7 themes, and 3 clusters of themes. The 3 clusters of themes were: ‘Identity conflict’, ‘Relationship role conflict’ and ‘Institutional role conflict’. CONCLUSION: The findings from this study suggest that legal status guarantees have to be prepared in order to resolve the role conflict of physician assistant nurses.
Data Collection ; Humans ; Jurisprudence ; Methods ; Physician Assistants ; Qualitative Research ; Statistics as Topic